Nosocomial infection in small for gestational age newborns with birth weight <1500 g: a multicentre analysis.
OBJECTIVE
To investigate whether preterm newborns who are small for gestational age are at increased risk of nosocomial infections and necrotising enterocolitis.


METHODS
The German national surveillance system for nosocomial infection in very low birthweight infants uses the US Centers for Disease Control and Prevention criteria. 2918 newborns (24-28 weeks), born between 2000 and 2004, were selected after application of predefined inclusion criteria to ensure similar proportions of small and appropriate weight for gestational age newborns across gestational age groups.


METHODS
The outcome criterion was at least one episode of nosocomial sepsis, pneumonia or necrotising enterocolitis. Adjusted odds ratios and corresponding 95% CIs were calculated based on general estimating equation models.


RESULTS
The study population consisted of 13% (n = 392) small and 87% (n = 2526) appropriate weight for gestational age infants. 33% (n = 950) of the infants experienced at least one episode of sepsis: 42% (n = 163) of small and 31% (n = 787) of appropriate weight for gestational age newborns (adjusted OR 1.41, 95% CI 1.05 to 1.89). Pneumonia was diagnosed in 6% (n = 171) of infants: 8.4% (n = 33) of small and 5.5% (n = 138) of appropriate weight for gestational age newborns (adjusted OR 1.57, 95% CI 1.19 to 5.57). Necrotising enterocolitis was documented in 5.2% (n = 152) of infants: 7.1% (n = 28) of small and 4.9% of (n = 124) appropriate weight for gestational age newborns (adjusted OR 1.20, 95% confidence interval 0.75 to 1.94).


CONCLUSIONS
Growth-retarded preterm infants seem to be at increased risk of nosocomial infection, irrespective of the responsible pathogen. Future immunological research should elucidate potential causal associations.
Bartels
Dorothee B
DB
Department of Epidemiology, Public Medicine and Healthcare Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, OE 5410, 30625 Hannover, Germany. bartels.dorothee@mh-hannover.de
Schwab
Frank
F
Geffers
Christine
C
Poets
Christian F
CF
Gastmeier
Petra
P
D003428:Cross Infection / Q000453:epidemiology*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology*; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*