Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia

Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objective: To predict incident bloodstream infection and urinary tract infection (UTI) in infants with congenital diaphragmatic hernia (CDH). Study design: We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010-2016. Infants with CDH admitted at 22 participating regional neonatal intensive care units were included; patients repaired or discharged to home prior to admission/referral were excluded. The primary outcome was death or the occurrence of bloodstream infection or UTI prior to discharge. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants. Results: Median gestation and postnatal age at referral in this cohort (n = 1085) were 38 weeks and 3.1 hours, respectively. The primary outcome occurred in 395 patients (36%); and was associated with low birth weight, low Apgar, low admission pH, renal and associated anomalies, patch repair, and extracorporeal membrane oxygenation (P <.001 for all; area under receiver operating curve = 0.824; goodness of fit χ2 = 0.52). After omitting death from the outcome measure, admission pH, patch repair of CDH, and duration of central line placement were significantly associated with incident bloodstream infection or UTI. Conclusions: Infants with CDH are at high risk of infection which was predicted by clinical factors. Early identification and low threshold for sepsis evaluations in high-risk infants may attenuate acquisition and the consequences of these infections.

Original languageEnglish (US)
Pages (from-to)101-107.e2
JournalJournal of Pediatrics
Volume203
DOIs
StatePublished - Dec 2018

Keywords

  • Children's Hospitals Neonatal Consortium (CHNC)
  • Children's Hospitals Neonatal Database (CHND)
  • congenital diaphragmatic hernia
  • neonatal intensive care
  • pulmonary hypertension

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group (2018). Predicting Risk of Infection in Infants with Congenital Diaphragmatic Hernia. Journal of Pediatrics, 203, 101-107.e2. https://doi.org/10.1016/j.jpeds.2018.07.032