title: Surgical site infections in the NICU.
abstract: BACKGROUND
  Surgical site infections (SSI) increase morbidity and mortality. In adult and pediatric populations, the incidence ranges from 1.5-12%. Studies in neonates have shown an association between preoperative stay in an intensive care unit and development of SSI. To date, there has only been a single study looking exclusively at SSI in the Neonatal Intensive Care Unit (NICU). Additionally, there has been a suggestion that prematurity may be a risk factor for SSI, but this has come from studies looking at all neonates less than 28days, rather than only neonates hospitalized in a NICU.
  
  
  OBJECTIVE
  Primary outcome variable was to calculate the incidence of SSI in a NICU population. Secondary outcome variables were to determine if SSI is more common in premature infants and to identify additional risk factors for the development of SSI.
  
  
  METHODS
  An IRB-approved retrospective chart review of all patients undergoing surgical procedures in a level IIIC NICU over a 2-year period was used. We utilized the CDC's definitions of surgical procedures and SSI. An epidemiologist reviewed charts if the diagnosis of SSI was questionable. Statistical analysis was done with t test and Fisher's exact test.
  
  
  RESULTS
  We identified 165 patients who underwent 264 surgical procedures. Incidence of SSI was 11.7%. There were 31 SSI that occurred in 29 neonates over the 2-year period, with no mortality in that group. In patients who developed an SSI, 34.5% occurred after the 1st procedure, 41.4% occurred after a 2nd procedure, and 24.1% occurred after the 3rd or later procedure. There was no difference in perioperative antibiotic usage.
  
  
  CONCLUSIONS
  This study describes SSI in a strictly neonatal population in a large academic NICU. Prematurity does not appear to be a risk factor for SSI. SSI is more common in neonates who have undergone an abdominal procedure or multiple procedures. Perioperative antibiotics are not significantly associated with prevention of SSI.
authors.affiliation: Department of Pediatrics/Division of Neonatology, Albany Medical Center, 43 New Scotland Ave, MC101, Albany, NY, 12208, USA. Electronic address: Kelly_Clements@pediatrix.com.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Clements
authors.affiliation: Department of Pediatrics/Division of Neonatology, Albany Medical Center, 43 New Scotland Ave, MC101, Albany, NY, 12208, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Albany Medical College, 43 New Scotland Ave, Albany, NY, 12208, USA.
authors.forename: Kofi
authors.initials: K
authors.lastname: Quaye
authors.affiliation: Department of Epidemiology, Albany Medical Center, 43 New Scotland Ave, Albany, NY, 12208, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: O'Donnell
authors.affiliation: Department of Surgery/Division of Pediatric Surgery, Albany Medical Center, 43 New Scotland Ave, Albany, NY, 12208, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Whyte
authors.affiliation: Department of Pediatrics/Division of Neonatology, Albany Medical Center, 43 New Scotland Ave, MC101, Albany, NY, 12208, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Horgan
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000209:etiology; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D009518:New York; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology
keywords: Neonate; Surgical site infection