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Nosocomial infection in small for gestational age newborns with birth weight <1500 g: a multicentre analysis

¹ Department of Epidemiology, Public Medicine and Healthcare Systems Research, Hannover Medical School, Hannover, Germany
² Institute of Hygiene, Charité-University Medicine in Berlin, Berlin, Germany
³ Department of Neonatology, University Children’s Hospital, Tübingen, Germany

Correspondence to:
Dr Dorothee B Bartels, Department of Epidemiology, Public Medicine and Healthcare Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, OE 5410, 30625 Hannover, Germany; bartels.dorothee{at}mh-hannover.de

Objective: To investigate whether preterm newborns who are small for gestational age are at increased risk of nosocomial infections and necrotising enterocolitis.

Design, setting and subjects: The German national surveillance system for nosocomial infection in very low birthweight infants uses the US Centers for Disease Control and Prevention criteria. 2918 newborns (24–28 weeks), born between 2000 and 2004, were selected after application of predefined inclusion criteria to ensure similar proportions of small and appropriate weight for gestational age newborns across gestational age groups.

Main outcome measures: The outcome criterion was at least one episode of nosocomial sepsis, pneumonia or necrotising enterocolitis. Adjusted odds ratios and corresponding 95% CIs were calculated based on general estimating equation models.

Results: The study population consisted of 13% (n = 392) small and 87% (n = 2526) appropriate weight for gestational age infants. 33% (n = 950) of the infants experienced at least one episode of sepsis: 42% (n = 163) of small and 31% (n = 787) of appropriate weight for gestational age newborns (adjusted OR 1.41, 95% CI 1.05 to 1.89). Pneumonia was diagnosed in 6% (n = 171) of infants: 8.4% (n = 33) of small and 5.5% (n = 138) of appropriate weight for gestational age newborns (adjusted OR 1.57, 95% CI 1.19 to 5.57). Necrotising enterocolitis was documented in 5.2% (n = 152) of infants: 7.1% (n = 28) of small and 4.9% of (n = 124) appropriate weight for gestational age newborns (adjusted OR 1.20, 95% confidence interval 0.75 to 1.94).

Conclusions: Growth-retarded preterm infants seem to be at increased risk of nosocomial infection, irrespective of the responsible pathogen. Future immunological research should elucidate potential causal associations.

Abbreviations: AGA, appropriate for gestational age; CDC, Centers of Disease Control and Prevention; CRIB, Clinical Risk Index for Babies; CPAP, continuous positive airway pressure; CVC, central venous catheter; GEE, general estimating equation; NEC, necrotising enterocolitis; PVC, peripheral venous catheter, SGA, small for gestational age

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