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 journalArticlepeer-review

10 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

Funding

Jeanette Asselin, David Durand (ex officio), Francine Dykes (ex officio), Jacquelyn Evans (Chair), Michael Padula, and Anthony Piazza, Kristina Reber and Billie Short are also board members of the Children's Hospitals Neonatal Consortium, Inc. For more information, please contact: [email protected]., We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children's Hospital's Neonatal Database (CHND). The site sponsors/contributors for the CHND are listed below: 1. Children's Healthcare of Atlanta, Atlanta, GA (Francine Dykes, Anthony Piazza) 2. Children's Healthcare of Atlanta at Scottish Rite (Gregory Sysyn) 3. Children's Hospital of Alabama, Birmingham, AL (Carl Coghill, Allison Black) 4. Le Bonheur Children's Hospital, Memphis, TN (Ramasubbareddy Dhanireddy) 5. Children's Hospital Boston, Boston, MA (Anne Hansen, Tanzeema Houssain) 6. Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia) 7. Cincinnati Children's Hospital, Cincinnati, OH (Beth Haberman, Breda Poindexter, Amy Nathan, Kristin Nelson, Paul Kingma, Stefanie Riddle, Stephanie Merhar, Heather Kaplan) 8. Nationwide Children's Hospital, Columbus, OH (Kristina Reber) 9. Children's Medical Center, Dallas, TX (Rashmin Savani, Luc Brion, Noorjahan Ali) 10. Children's Hospital Colorado, Aurora, CO (Theresa Grover) 11. Children's Hospital of Michigan, Detroit, MI (Girija Natarajan) 12. Cook Children's Health Care System, Fort Worth, TX (Jonathan Nedrelow, Annie Chi, Yvette Johnson) 13. Texas Children's Hospital, Houston, TX (Gautham Suresh) 14. Riley Children's Hospital, Indianapolis, IN (William Engle, Lora Simpson, Gregory Sokol) 15. Children's Mercy Hospitals and Clinics, Kansas City, MO (Eugenia Pallotto) 16. Arkansas Children's Hospital, Little Rock, AR (Robert Lyle, Becky Rogers) 17. Children's Hospital Los Angeles, Los Angeles, CA (Lisa Kelly*, Steven Chin, Rachel Chapman) 18. American Family Children's Hospital, Madison, WI (Jamie Limjoco, Lori Haack) 19. Children's Hospital & Research Center Oakland, Oakland, CA (David Durand, Jeanette Asselin, Art D'Harlingue, Priscilla Joe) 20. The Children's Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula, David Munson) 21. St. Christopher's Hospital for Children, Philadelphia, PA (Suzanne Touch) 22. Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Beverly Brozanski) 23. St. Louis Children's Hospital, St Louis, MO (Tasmin Najaf, Rakesh Rao, Amit Mathur) 24. All Children's Hospital, St. Petersburg, FL (Victor McKay) 25. Rady Children's Hospital, San Diego, CA (Mark Speziale, Brian Lane, Laural Moyer) 26. Children's National Medical Center, Washington, DC (Billie Short) 27. AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan) 28. Primary Children's Medical Center, Salt Lake City, UT (Con Yee Ling, Shrena Patel) 29. Children's Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta) 30. Children's Hospital of Omaha (Lynne Willett, Nicole Birge) 31. Florida Hospital for Children (Rajan Wadhawan) 32. Seattle Children's Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert DiGeronimo, Zeenia Billimoria) 33. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee) 34. Children's Hospital Orange County, Los Angeles, CA (Michel Mikhael, Irfan Ahmad), *deceased.

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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