Risk factors for nosocomial infections in critically ill newborns: a 5-year prospective cohort study.
BACKGROUND
Nosocomial infections (NIs) are one of the most important causes of morbidity in neonatal intensive care units (NICUs). The aim of this study was to identify risk factors (RFs) for NIs among critically ill newborn patients in a Brazilian NICU.


METHODS
This 5-year prospective cohort study in an 8-bed NICU included all infants born in the hospital and admitted to the NICU from 1993 to 1997. Exposure variables were maternal and newborn data prospectively collected from patient records. Univariate and multivariate analyses were used to determine independent RFs associated with NIs.


RESULTS
Univariate analysis indicated gestational age, congenital abnormality, premature rupture of membranes, maternal illness, birth weight, mechanical ventilation, central venous catheter, total parenteral nutrition, peripheral venous catheter, and length of stay as possible RFs. Multivariate analysis identified 5 independent RFs for NIs: premature rupture of membranes (hazard ratio [HR] = 1.51 [95% CI, 1.15-1.99]), maternal disease (HR = 1.57 [95% CI, 1.18-2.07]), mechanical ventilation (HR = 2.43 [95% CI, 1.67-3.53]), central venous catheter (HR = 1.70 [95% CI, 1.21-2.41]), and total parenteral nutrition (HR = 4.04 [95% CI, 2.61-6.25]).


CONCLUSIONS
The recognition of RFs for NIs is an important tool for the identification and development of interventions to minimize such risks in the NICU.
Kawagoe
J Y
JY
Hospital Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Segre
C A
CA
Pereira
C R
CR
Cardoso
M F
MF
Silva
C V
CV
Fukushima
J T
JT
D000704:Analysis of Variance; D001724:Birth Weight; D001938:Brazil / Q000453:epidemiology; D002408:Catheters, Indwelling / Q000009:adverse effects; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005865:Gestational Age; D006769:Hospitals, General; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy; D017053:Infection Control / Q000379:methods / Q000592:standards; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors