title: Outcomes and risk factors of ventilator-associated pneumonia in neonates.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome. This study aimed to compare the incidence, risk factors, and outcomes of VAP and non- VAP conditions in neonates.
  
  
  METHODS
  We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014. All neonatal patients who were ventilated more than 48 hours were enrolled.
  
  
  RESULTS
  There were 128 enrolled patients. The median (inter quartile range) gestational age and birthweight were 35 (30.2, 37.8) weeks and 2380 (1323.8, 3020.0) g. There were 17 VAP patients (19 episodes) and 111 non-VAP ones. The VAP rate was 13.3% or 10.1 per 1000 ventilator days. According to the multivariate analysis, a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75, 95% confidence interval (CI)=2.35-49.16; P=0.002] and sedative medication use (aOR=4.00, 95% CI=1.23-12.50; P=0.021) were independent risk factors for VAP. Compared with the non-VAP group, the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days, P=0.001), total length of hospital stay (16 days, P=0.002) and higher hospital costs ($5113, P=0.001). The inhospital mortality rate in the VAP and non-VAP groups was 17.6% and 15.3% (P=0.73), respectively.
  
  
  CONCLUSIONS
  A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP. Our VAP patients experienced a longer duration of both NICU and hospital stay, and incurred higher hospitalization costs.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand. anuchanicu@hotmail.com.
authors.forename: Anucha
authors.initials: A
authors.lastname: Thatrimontrichai
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
authors.forename: Natthaka
authors.initials: N
authors.lastname: Rujeerapaiboon
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
authors.forename: Waricha
authors.initials: W
authors.lastname: Janjindamai
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
authors.forename: Supaporn
authors.initials: S
authors.lastname: Dissaneevate
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
authors.forename: Gunlawadee
authors.initials: G
authors.lastname: Maneenil
authors.affiliation: Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Supika
authors.initials: S
authors.lastname: Kritsaneepaiboon
authors.affiliation: Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Pattama
authors.initials: P
authors.lastname: Tanaanantarak
mesh_terms: D015331:Cohort Studies; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013785:Thailand; D016896:Treatment Outcome
keywords: mechanical ventilation; newborn; risk factor; sedatives; ventilator-associated pneumonia