title: Interpreting positive cultures of endotracheal aspirates: factors associated with treatment decisions in ventilated neonates.
abstract: OBJECTIVE
  Diagnosis of ventilator-associated pneumonia in newborns is challenging because of ease of colonisation, non-specific chest radiograph changes and lack of a consensus definition. The aims of this study were to review treatment decisions in neonates with culture-positive endotracheal aspirate and to assess impact on respiratory outcomes using blinded review of radiological studies.
  
  
  METHODS
  Charts from all very low birthweight neonates ventilated for >48 h and with positive culture were assessed. Chest radiographs were reviewed by a radiologist masked to the grouping of the episode (treated/not treated). Clinical, investigational and radiological features used in practice were assessed on impact on treatment decisions. Association between treatment and outcomes was assessed.
  
  
  RESULTS
  Seventy-four episodes of culture-positive endotracheal aspirate were analysed in 38 babies. Fifty-eight episodes were treated with antibiotics. Gestational age at birth and birthweight in both groups (treated vs. non-treated) were statistically comparable (25.5 ± 3.1 vs. 27.2 ± 2.3 weeks and 809 ± 302 vs. 870 ± 262 g). Comparative chest radiographs were available in 51 of 58 treated episodes; deterioration was noted in 42 (82.3%). Ventilatory parameters were significantly higher in the treatment group and showed a significant improvement after antibiotics. Twenty-three babies developed chronic lung disease. Odds ratio (of having chronic lung disease when treatment is initiated) was 4.5 (95% confidence interval = 0.97-20.8, P= 0.06).
  
  
  CONCLUSIONS
  Treated culture-positive aspirate episodes were accompanied by higher ventilatory requirements, increased symptoms and elevated septic markers. Need for treatment was associated with greater likelihood of developing chronic lung disease.
authors: Monash Newborn, Monash Children's , Monash University, Victoria, Australia.
authors: Florence
authors: F
authors: Murila
authors: Johny V
authors: JV
authors: Francis
authors: Amy
authors: A
authors: Bland
authors: Surekha
authors: S
authors: Kumbla
authors: Richard
authors: R
authors: Doherty
authors: Arvind
authors: A
authors: Sehgal
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D003657:Decision Making; D006801:Humans; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008485:Medical Audit; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014739:Victoria