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Risk Factors Associated With Laboratory-confirmed Bloodstream Infections in a Tertiary Neonatal Intensive Care Unit

Padula, Michael A. MD, MBI*†‡; Dewan, Maya L. MD, MPH; Shah, Samir S. MD, MSCE§; Padula, Amy M. PhD, MSc; Srinivasan, Lakshmi MB BS*†‡; McGowan, Karin L. PhD, MS; Mahoney, Kaitilin R. BA*; Harris, Mary C. MD*†‡

The Pediatric Infectious Disease Journal: October 2014 - Volume 33 - Issue 10 - p 1027–1032
doi: 10.1097/INF.0000000000000386
Original Studies

Background: Bloodstream infections (BSI) remain a leading cause of morbidity and mortality among infants admitted to neonatal intensive care units (NICUs). At the time of evaluation for suspected BSI, presenting signs may be nonspecific. We sought to determine the clinical signs and risk factors associated with laboratory-confirmed BSI among infants evaluated for late-onset sepsis in a tertiary NICU.

Methods: This prospective cohort study included infants >3 days of age admitted to a level 4 NICU from July 2006 to October 2009 for whom a blood culture was drawn for suspected sepsis. Clinicians documented presenting signs at the time of culture. Laboratory-confirmed BSI was defined as per the National Healthcare Safety Network. Multivariate analyses were performed using a logistic regression random effects model.

Results: Six-hundred and eighty eligible episodes of suspected BSI were recorded in 409 infants. Enteral contrast within the preceding 48 hours was the most significant risk factor for laboratory-confirmed BSI [Odds Ratio: 9.58 (95% confidence interval: 2.03–45.19)] followed by presence of a central venous catheter. Apnea and hypotension were the most strongly associated presenting signs.

Conclusion: Among infants evaluated in a tertiary NICU, recent exposure to enteral contrast was associated with increased odds of developing BSI. Apnea and hypotension were the most strongly associated clinical signs of infection.

From the *Division of Neonatology; Department of Pediatrics, The Children’s Hospital of Philadelphia; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; §Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA; and Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA.

Accepted for publication April 16, 2014.

The authors have no funding or conflicts of interest disclose.

Address for correspondence: Michael A. Padula, MD, MBI, The Children’s Hospital of Philadelphia, Division of Neonatology, 2NW49 Main, 34th St. & Civic Center Blvd., Philadelphia, PA 19104. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.