The online version of this article (doi:10.1186/s12887-017-0855-3) contains supplementary material, which is available to authorized users.
Late-onset sepsis (LOS), defined as sepsis occurring after 48 h of age causes substantial mortality and morbidity in very low birth weight infants. Risk factors for LOS include immaturity, intravascular catheters, mechanical ventilation, and prolonged parenteral nutrition (PN). Little attention has been paid to studying the effects of PN administration methods. The aim of the study was to compare a bundle of measures for PN line management incorporating a strict aseptic technique with standard line management on LOS in very low birth weight infants.
Infants <1500 g birth weight who required PN were randomised to either a bundle of a strict aseptic technique for line management together with single use intravascular catheter for PN or a standard technique. The primary outcome was the incidence of LOS in the first 28 days of life. Secondary outcomes were mortality, neonatal morbidities and developmental outcome at 12 months of age.
There were 126 infants in the aseptic technique group and 123 in the standard technique group. Forty (31.8%) infants in the aseptic technique group and 36 (29.3%) in the standard technique group had an episode of sepsis (p = 0.77). This corresponds to incidences of 15.8 and 14.2 episodes of sepsis per 1000 patient days respectively. Subgroup analyses for infants <1000 g also revealed no difference in the rate of sepsis between the intervention and control groups. (p = 0.43). There were no significant differences in secondary outcomes and development between the groups.
A bundle of measures including strict aseptic technique for parenteral nutrition line management did not result in a reduction in LOS when compared to a standard technique. There is no evidence to recommend this as routine practice.
Interdisciplinary Maternal Perinatal Australasian Collaborative Trials (IMPACT) Network, TRN registration number: PT0363. Date: 06/03/2001; Australian New Zealand Clinical Trials Registry (ANZCTR), TRN registration number: ACTRN12617000455369. Date: 28/03/2017 (retrospectively registered).
Additional file 1: Parenteral nutrition line management techniques. Description of data: Details of the parenteral nutrition line change management – study intervention bundle and standard technique. (DOCX 20 kb)12887_2017_855_MOESM1_ESM.docx
Avila-Figueroa C, Goldmann DA, Richardson DK, Gray JE, Ferrari A, Freeman J. Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns. Pediatr Infect Dis J 1998;17:10–17.
Alcock G, Liley H, Wodgate P, Tudehope D, Coory, M. First episodes of late onset sepsis in very low birth weight infants. A case controlled study Pediatr Res 2002;51:305A.
Shah J, Jeffries AL, Yoon EW, Lee SK. Shah PS. Canadian Neonatal Network Am J Perinatol. 2015;32:675–82. PubMed
Ng PC, Wong HL, Lyon DJ, So KW, Liu F, Lam RK, et al. Combined use of alcohol hand rub and gloves reduces the incidence of late onset infection in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2004;89:336–40. CrossRef
International Neonatal Network. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. Lancet. 1993;342:193–8. CrossRef
Richardson D, Gray J, McCormick M, Workman K, Goldmann D. Score for neonatal acute physiology. A physiologic severity index for neonatal intensive care. Pediatrics. 1993;91:617–23. PubMed
Griffiths R. The Griffiths Mental Development Scales. Henley on Thames: Association for Research in Infant and Child Development 1996.
Cartwright D. The Grantly Stable Neonatal Unit Annual Clinical Report. Brisbane: The Royal Women’s hospital;2002.
Bowen JR, Callander I, Richards R, Lindrea KB, For the sepsis prevention in NICUs group. Decreasing infection in neonatal intensive care units through quality improvement. Arch Dis Child Fetal Neonatal Ed 2016;0:F1-F7. doi: 10.1136/archdischild-2015-310165.
Stoll BJ, Hansen NI, Adams-chapman I, Fanaroff AA, Hintz SR, Vohr B, for the National Institute of Child Health and Development Neonatal Research Network, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292:2357–65. CrossRefPubMed
- Prevention of neonatal late-onset sepsis: a randomised controlled trial
Helen G. Liley
Peter H. Gray
- BioMed Central
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