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European Journal of Pediatrics

, Volume 173, Issue 4, pp 427–434 | Cite as

Risk factors for ventilator-associated pneumonia in the neonatal intensive care unit: a meta-analysis of observational studies

  • Bin Tan
  • Fan Zhang
  • Xian Zhang
  • Ya-Ling Huang
  • Yu-Shuang Gao
  • Xiao Liu
  • Ying-Li Li
  • Jing-Fu Qiu
Review

Abstract

Ventilator-associated pneumonia (VAP) is a common and serious problem among mechanically ventilated patients in intensive care units (ICU), especially for the newborn. However, limited literatures have been reviewed to synthesize the finding of previous papers to investigate the risk factors for VAP although it has been a serious complication of mechanical ventilation (MV) with a high morbidity and mortality in the newborn. We performed this meta-analysis to extend previous knowledge for developing VAP prevention strategies by identifying the potential risk factors related to VAP in the neonatal intensive care unit (NICU). The relevant literatures published up to July 2013 were searched in the databases of PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science. Three reviewers screened those literatures and extracted data according to the inclusion and exclusion criteria independently. A total of eight studies including 370 cases and 1,071 controls were identified. Ten risk factors were found to be related to neonatal VAP which were listed as follows in order by odds ratios (ORs): length of stay in NICU (OR 23.45), reintubation (OR 9.18), enteral feeding (OR 5.59), mechanical ventilation (OR 4.04), transfusion (OR 3.32), low birth weight (OR 3.16), premature infants (OR 2.66), parenteral nutrition (OR 2.30), bronchopulmonary dysplasia (OR 2.21), and tracheal intubation (OR 1.12). Conclusion: We identified ten variables as independent risk factors for the development of VAP: length of stay in NICU, reintubation, enteral feeding, mechanical ventilation, transfusion, low birth weight, premature infants, parenteral nutrition, bronchopulmonary dysplasia, and tracheal intubation. Due to several limitations in the present study, further large and well-designed studies are needed to confirm the conclusion.

Keywords

Neonatal Ventilator-associated pneumonia Risk factors Meta-analysis 

Abbreviations

VAP

Ventilator-associated pneumonia

ICU

Intensive care units

NICU

Neonatal intensive care unit

PICU

Pediatric intensive care unit

MV

Mechanical ventilation

OR

Odds ratio

CI

Confidence interval

NOS

Newcastle–Ottawa Scale

RCT

Randomized controlled trial

PARP

Population attributable risk proportion

LBW

Low birth weight

LOS

Length of stay

UVC

Umbilical vein catheterization

NRDS

Neonate respiratory distress syndrome

MAS

Meconium aspiration syndrome

HIE

Hypoxic ischemic encephalopathy

BPD

Bronchopulmonary dysplasia

BSI

Bloodstream infection

SD

Standard deviation

Notes

Acknowledgments

This study was supported by the National Natural Science Foundation of China (31071093, 31170129, 31200064) and Natural Science Foundation of Chongqing (CSTC, 2010BB5354, 2010BB5103).

Conflict of interest

The authors declared that they have no conflict of interest. The authors have no financial relationship with the organization that sponsored the research.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Bin Tan
    • 1
  • Fan Zhang
    • 1
  • Xian Zhang
    • 1
  • Ya-Ling Huang
    • 1
  • Yu-Shuang Gao
    • 1
  • Xiao Liu
    • 1
  • Ying-Li Li
    • 1
  • Jing-Fu Qiu
    • 1
  1. 1.School of Public Health and ManagementChongqing Medical UniversityChongqingChina

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