Sepsis risk factors in infants with congenital diaphragmatic hernia.
BACKGROUND
Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most challenging ICU-managed disease. Beside severe pulmonary hypertension, lung hypoplasia and major abdominal surgery, infective complications remain major determinants of outcome. However, the specific incidence of sepsis as well as associated risk factors is unknown.


METHODS
This prospective, 4-year observational study took place in the pediatric intensive care and neonatal medicine department of the Paris South University Hospitals (Le Kremlin-Bicêtre, France), CDH national referral center and involved 62 neonates with CDH.


RESULTS
During their ICU stay, 28 patients (45%) developed 38 sepsis episodes. Ventilator-associated pneumonia (VAP: 23/38; 31.9 VAP per 1000 days of mechanical ventilation) and central line-associated blood stream infections (CLABSI: 5/38; 5.5 per 1000 line days) were the most frequently encountered infections. Multivariate analysis showed that gestational age at birth and intra-thoracic position of liver were significantly associated with the occurrence of sepsis. Infected patients had longer duration of mechanical and noninvasive ventilation (16.2 and 5.8 days, respectively), longer delay to first feeding (1.2 days) and a longer length of stay in ICU (23 days), but there was no difference in mortality.


CONCLUSIONS
Healthcare-associated infections, and more specifically VAP, are the main infective threat in children with CDH. Sepsis has a significant impact on the duration of ventilator support and ICU length of stay but does not impact mortality. Low gestational age and intra-thoracic localization of the liver are two independent risk factors associated with sepsis.
Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, 78, Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.|Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France.
Michaël
M
Levy
Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, 78, Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.|Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France.
Nolwenn
N
Le Sache
Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France.
Mostafa
M
Mokhtari
INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), Paris South University, 94805, Villejuif, France.
Guy
G
Fagherazzi
Bacteriology-Hygiene Unit, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
Gaelle
G
Cuzon
Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, 78, Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Benjamin
B
Bueno
Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France.|Pediatric Surgery, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.|School of Medicine, Paris South University, UPS11, Le Kremlin-Bicêtre, France.
Virginie
V
Fouquet
Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France.|School of Medicine, Paris South University, UPS11, Le Kremlin-Bicêtre, France.|Obstetrics, Gynecology and Reproductive Medicine, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris, Clamart, France.
Alexandra
A
Benachi
Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, 78, Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.|Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France.|Institute of Integrative Biology of the Cell, CNRS, CEA, Univ. Paris Sud, Paris Saclay University, Gif-sur-Yvette, France.
Sergio
S
Eleni Dit Trolli
Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, 78, Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France. pierre.tissieres@aphp.fr.|Centre de référence Maladie Rare: Hernie de Coupole Diaphragmatique, 94270, Le Kremlin-Bicêtre, France. pierre.tissieres@aphp.fr.|School of Medicine, Paris South University, UPS11, Le Kremlin-Bicêtre, France. pierre.tissieres@aphp.fr.|Institute of Integrative Biology of the Cell, CNRS, CEA, Univ. Paris Sud, Paris Saclay University, Gif-sur-Yvette, France. pierre.tissieres@aphp.fr.
Pierre
http://orcid.org/0000-0001-5423-5532
P
Tissieres
Central line-associated bloodstream infection; Congenital diaphragmatic hernia; Healthcare-associated infection; Sepsis; Ventilator-associated pneumonia