Oral or Poster Presentation
Concurrent Session 3A - Neonatal Clinical Epidemiology
Introduction: Our aim was to test the hypothesis that late onset culture positive bloodstream infection (CPBSI) and late onset meningitis (culture positive, with or without CPBSI) in very preterm infants have different incidence trends and risk factors.
Methods: We conducted a retrospective cohort study of all infants <33 weeks GA who were admitted to Canadian Neonatal Network NICUs from January 1, 2010 to December 31, 2018. We excluded infants who were moribund on admission, had major congenital anomalies or were missing date of birth. We used the Cochrane Armitage trend test to compare the trends of incidence of CPBSI only and meningitis. For risk analysis, we classified infants into three groups: no infection, meningitis and CPBSI only. We used chi-square or F-test to compare baseline characteristics and interventions, and multiple multinomial logistic regression to identify risk factors and examine the association between meningitis and mortality and major morbidity.
Results: Among the 36,573 eligible infants included in the analyses, 32,198 (88%), 3,977 (11%) and 398 (1.1%) had no infection, CPBSI and meningitis respectively. The incidence of CPBSI decreased by 31% (p<0.01) from 2010 to 2018, but there was no decrease in incidence of meningitis (p=0.51) (Figure 1). The odds of having meningitis versus CPBSI was significantly (p<0.01) increased for infants with severe intraventricular hemorrhage (AOR =3.6, 95% CI 2.81,4.65) and SNAPII>20 (AOR=1.45, 95% CI 1.13,1.88), but decreased for infants who were born by caesarean section (AOR 0.71, 95% CI 0.56,0.90) or had maternal hypertension (AOR 0.6, 95% CI 0.41,0.89).
Conclusion: Between 2010 and 2018, the incidence of CPBSI decreased but not meningitis. The risk of meningitis versus CPBSI was increased with severe intraventricular hemorrhage and SNAPII>20, but decreased with caesarean section and maternal hypertension. It is possible that meningitis and CPBSI have different risk factors and require different strategies for reduction.