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J Perinatol. 2019 Aug 5. doi: 10.1038/s41372-019-0435-5. [Epub ahead of print]

Extracorporeal membrane oxygenation and bloodstream infection in congenital diaphragmatic hernia.

Author information

1
Children's Healthcare of Atlanta at Egleston and Emory University School of Medicine, Atlanta, GA, USA. skeene@emory.edu.
2
Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA.
3
Ann & Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
4
Children's Mercy Hospital and University of Missouri, Kansas City, MO, USA.
5
Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
6
Children's Hospital Association, Overland Park, KS, USA.
7
Cook Children's Hospital, Fort Worth, TX, USA.
8
Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.
9
Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
10
Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, 98195, USA.
11
Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

Abstract

OBJECTIVE:

To characterize the risk of bloodstream (BSI) and urinary tract infection (UTI) and describe antibiotic use in infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO).

STUDY DESIGN:

The Children's Hospitals Neonatal Database was queried for infants with CDH and ECMO treatment from 2010 to 2016. The outcomes included BSI, UTI, and antimicrobial medication. Member institutions completed a survey on infection practices.

RESULT:

Eighteen of the 338 patients identified (5.3%) had ≥1 BSI during their ECMO course. The likelihood of BSI increased with time: 1.2/1000 ECMO days; 0.6% (2/315) in the first week and rising to 14.6/1000; 8.6% (5/58) after 21 days (p = 0.002). More than 95% of patients received antibiotics each week on ECMO.

CONCLUSIONS:

Confirmed BSI is rare in infants with CDH treated with ECMO in the first week, but increases with the duration of ECMO. Use of antibiotics was extensive and did not correspond to infection frequency.

PMID:
31383944
DOI:
10.1038/s41372-019-0435-5

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