Analysis Of Clinical Characteristics Of 71 Neonates With Ventilator-asssociated Pneumonia

Objective:To analyze clinical characteristics of neonatal ventilator-associated pneumonia(VAP)and differences between early-and late-onset VAP,in order to provide evidence-based support for the treatment and prevention of neonatal VAP.Methods:The clinical data of 332 cases of neonates who had mechanical ventilation for more than 48 hours in the neonatal intensive care unit(NICU)of Children's Hospital of Soochow University from September 2016 to December 2019 were collected.This infants were divided into the tow groups,VAP group and non-VAP group according to VAP diagnositic criteria.Then the VAP group were classified by ventilator status:early-onset VAP(<5d ventilation,E-VAP)or late-onset VAP(?5d ventilation,L-VAP).The general information,clinical manifestation,laboratory examination,complication,mechanical ventilation,treatment and outcome of the neanates were retrospectively analysed,and multivariate regression analysis was used to explore the risk factors of early-and late-onset VAP.Results:1.General case:A total of 332 cases of neonates who had mechanical ventilation for more than 48 hours in the neonatal intensive care unit were recruited.Of 332 cases,71 cases were the VAP children while 261 cases were the non-VAP children,and in VAP group,24 cases were the early-onset VAP,47 cases were the late-onset VAP.The incidence of nenatal VAP was 21.4%.The average gestational age in VAP group was(31.7±4.8)weeks,and the average birth weight was(1830±973)g.The average gestational age in non-VAP group was(35.5±3.7)weeks,and the average birth weight was(2596±851)g.Comparing with VAP group,non-VAP group had older gestational age,larger birth weight,there were significant differences between 2 groups(P<0.05).2.Complication,laboratory examination and treatment:The incidencs of complications in VAP group including neonatal respiratory distress syndrome(NRDS),pulmonary haemorrhage,bronchopulmonary dysplasia(BPD),asphyxia was higher than in non-VAP group,there were significant differences between 2 groups(P<0.05).The average serum albumin level in VAP group[(28.09±4.37)g/L]was less than in non-VAP group[(30.28±3.53)g/L],there were significant differences between 2 groups(P<0.05).Rate of red blood cell transfusion in VAP group was higher than in non-VAP group,there were significant differences between 2 groups(P<0.05).3.Mechanical ventilation and outcome:Comparing with the non-VAP group,the VAP group had more tracheal intubation,longer mechanical ventilation,longer hospitalization,and higher mortality,there were significant differences between 2 groups(P<0.05).4.Comparison of E-VAP and L-VAP:The average gestational age in E-VAP group was(33.6±4.7)weeks,and the average birth weight was(2197±1120)g.The average gestational age in L-VAP group was(30.7±4.6)weeks,and the average birth weight was(1648±840)g.Comparing with L-VAP group,E-VAP group had older gestational age,larger birth weight,there were significant differences between 2 groups(P<0.05).The incidences of complications in L-VAP group including NRDS,BPD was higher than in E-VAP group,while the incidences of complications in E-VAP group including critical illness at admission was higher than in L-VAP group,there were significant differences between 2 groups(P<0.05).Number of red blood cell transfusion was higher in L-VAP group than in E-VAP group,and L-VAP group had longer mechanical ventilation and longer hospitalization,there were significant differences between 2 groups(P<0.05).5.The univariate analysis showed that the risk factors affecting VAP include small gestational age,low birth weight,increased mechanical ventilation time,increased number of tracheal intubations,prolonged hospitalization,combined NRDS,combind asphyxia,low albumin levels and influsion of red blood cell suspension(P<0.05).The multivariate logistic regression analysis showed that main risk factors affecting early-onset VAP include increased mechanical ventilation time and increased number of tracheal intubations;main risk factors affecting late-onset VAP include increased mechanical ventilation time,increased number of tracheal intubations,prolonged hospitalization and combined NRDS(P<0.05).Conclusion:1.The yonger the gestational age,the lower the birth weight,the more tracheal intubation and the longer the mechanical ventilation,the higher incidence of neonatal VAP.2.Neonates with late-onset VAP have a smaller gestational age,lighter birth weight and a highter proportion of NRDS and BPD,whereas neonates with early-onset VAP have a higher proportion of critical illness at admission.3.Comparing with early-onset VAP group,neonates with late-onset VAP have longer mechanical ventilation,longer hospitalization and a higher number of red blood cell transfusion.4.Main risk factors affecting early-onset VAP include increased mechanical ventilation time and increased number of tracheal intubations;main risk factors affecting late-onset VAP include increased mechanical ventilation time,increased number of tracheal intubations,prolonged hospitalization and combined NRDS(P<0.05).