Risk Factors Of Neonatal Ventilator-Associated Pneumonia And Application Of Bundle Strategies

Objective:To explore the high-risk factors of neonatal ventilator-associated pneumonia(VAP)and the effect of bundle strategies on the occurrence of VAP.Provide a reference for the clinical prevention and treatment of neonatal VAP to reduce the incidence of VAP and neonatal mortality.Methods:A total of 198 neonates who were treated with tracheal intubation and mechanical ventilation for more than 48 hours in the NICU from October 2017 to December 2019 in Lianyungang Maternal and Child Health Hospital were selected as the research subjects.They were divided into the investigation period(October 2017 to 2018 September),transition period(October 2018-December 2018),and expectations(January 2019-December 2019),each period is again divided into VAP group and non-VAP group.Retrospective collection of all children’s gender,gestational age,birth weight,1-minute Apgar,primary disease,history of PS use,sedative drug use,duration of mechanical ventilation,number of tracheal intubations,number of airway aspirations,chest radiography,sputum Cultivation,and other clinical data.Single-factor regression analysis of VAP risk was performed on the data of children during the survey period,followed by multi-factor Logistic regression analysis to observe the risk factors affecting neonatal VAP.Subsequently,the bundle strategies strategy developed by our hospital was gradually adopted in the clinic to analyze the occurrence of VAP during the intervention period.Results:1.There were 198 neonates in three stages,including 78 cases in the investigation period,28 cases in the transition period,and 92 cases in anticipation.The gender,gestational age,birth weight,production mode,and 1-minute Apgar score in the three periods were basic.There was no statistical difference between the conditions(P>0.05).2.Analyze the data of 78 neonates during the investigation period.The gestational age,birth weight,whether to use PS,whether to be re-intubated,the number of aspirations in the airway,and the mechanical ventilation time were the factors that affected the occurrence of VAP.Multivariate Logistic regression analysis showed that low birth weight,multiple tracheal intubations,and long mechanical ventilation were independent risk factors for neonatal VAP,with OR values of 4.341,5.570,and 1.939,respectively,P<0.05.3.A total of 29 lower respiratory tract pathogens were detected in 29 of the 40 children with VAP during the study period,and the positive rate was 72.5%.A total of 35 pathogens were isolated.The main gram-negative bacteria were 29 cases,accounting for 80.00%.The top three were Klebsiella pneumonia(22.86%),Acinetobacter baumannii(17.14%),and Pseudomonas aeruginosa(17.14%).The above bacteria are still sensitive to carbapenems and quinolones,and the remaining antibiotics are relatively resistant.4.After using the clustering intervention strategy,the incidence of VAP decreased from 33.29‰ during the survey period to 16.48‰,and the incidence of VAP decreased significantly after the intervention(P<0.05).There were no significant differences in mortality,per capita mechanical ventilation time,and length of hospital stay before and after the intervention.Conclusions:1.The high-risk factors for neonatal ventilator-associated pneumonia include low birth weight,long mechanical ventilation,and multiple tracheal intubations.2.The main pathogens of neonatal VAP are Gram-negative bacteria,mainly Klebsiella pneumonia,Acinetobacter baumannii,and Pseudomonas aeruginosa.3.The incidence of neonatal ventilator-associated pneumonia in our hospital decreased significantly after the use of clustering intervention strategies.However,there were no significant changes in mortality,per capita mechanical ventilation,and length of hospital stay.