Risk Factors for Surgical Site Infection in Neonates: A Systematic Review of the Literature and Meta-Analysis

Abstract

Purpose: Surgical site infections (SSI) contribute to postoperative morbidity and mortality in children. Our aim was to evaluate the prevalence and identify risk factors for SSI in neonates. Methods: Using a defined strategy, three investigators searched articles on neonatal SSI published since 2000. Studies on neonates and/or patients admitted to neonatal intensive care unit following cervical/thoracic/abdominal surgery were included. Risk factors were identified from comparative studies. Meta-analysis was conducted according to PRISMA guidelines using RevMan 5.3. Data are (mean ± SD) prevalence. Results: Systematic review—of 885 abstracts screened, 48 studies (27,760 neonates) were included. The incidence of SSI was 5.6% (1,564 patients). SSI was more frequent in males (61.8%), premature babies (77.4%), and following gastrointestinal surgery (95.4%). Meta-analysis—10 comparative studies (16,442 neonates; 946 SSI 5.7%) showed that predictive factors for SSI development were gestational age, birth weight, age at surgery, length of surgical procedure, number of procedure per patient, length of preoperative hospital stay, and preoperative sepsis. Conversely, preoperative antibiotic use was not significantly associated with development of SSI. Conclusions: Younger neonates and those undergoing abdominal procedures are at higher risk for SSI. Given the lack of evidence-based literature, prospective studies may help determine the risk factors for SSI in neonates.

The incidence of abdominal surgical site infections after abdominal birth defects surgery in infants: A systematic review with meta-analysis

“…However, recent studies show that prolonged antibiotic exposure in infants could result in serious side effects: antibiotics alter gut microbiota, increase risk of necrotizing enterocolitis, late onset sepsis and even death [173 , 174] . Additionally a recent systematic review showed that pre-operative antibiotic treatment did not influence the occurrence of surgical site infections in neonates [175] . Yet, this lack of effectiveness in neonates could be explained by a lack of appropriate timing of administration, which could be improved by correct protocol adherence [177] .…”

Magnitude, bacterial etiology profile and associated factors of surgical site infection in Ethiopia: Systematic review and meta-analysis

“…Accordingly, the national pooled prevalence of SSI was 11.58 (95% CI 9.78, 13.38). This result was relatively higher than annual epidemiological report for 2016 of SSI by European Centre for Disease Prevention and Control (ECDC) ranged between 0.5% to 9.0%, depending on the type of surgical procedure [43]; and from meta analysis result of SSI among neonates (5.6%) [44] and in China (4.5%) [45]. The lower prevalence of SSI in developed counties may be due to strong economies, having a high set up hospitals, their degree of adherence to aseptic techniques and surgical procedure may be done by well experienced surgeons.…”

Incisional hernia after abdominal surgery in infants: A retrospective analysis of incidence and risk factors

“…In paediatric patients, proper administration of preoperative antibiotics is also widely accepted as one of the few risk factors which can be influenced [17] . However, ambiguity on this effect exists in neonates [18] . This is possibly explained by a lack of appropriate timing of perioperative antibiotic administration, as a result of improper protocol adherence or even the absence of protocols [19] .…”