Jonathan W Davis1, David Odd2,3, Sally Jary1,3, Karen Luyt1,3. 1. Regional Neonatal Unit, St. Michael's Hospital, University Hospitals Bristol Foundation NHS Trust, Bristol, UK. 2. Regional Neonatal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. 3. School of Clinical Sciences, University of Bristol, Bristol, UK.
Abstract
OBJECTIVE: Very low birthweight (VLBW; <1500 g) infants with late-onset sepsis (LOS) have an increased risk of neurodisability. Care bundles to reduce bloodstream infections in neonatal intensive care unit (NICU) are effective in reducing LOS. Our aim was to determine if a sepsis reduction bundle introduced through a quality improvement project would impact neurodevelopmental outcomes in VLBW infants. DESIGN: Cohort study. SETTING: Level 3 regional NICU in the South West of England. PATIENTS: VLBW infants born between 2002 and 2011. INTERVENTIONS: A sepsis reduction care bundle implemented between July 2006 and December 2007. MAIN OUTCOME MEASURES: The primary outcome was risk of coagulase-negative Staphylococcus (CONS) infection diagnosed >3 days of age. Secondary outcomes were death and moderate cognitive impairment. A logistic regression model was derived using the birth era as the independent variable with adjustment for typical confounders. RESULTS: In total, 379 infants were born in the preintervention cohort and 378 in the postintervention cohort. The CONS infection rate was reduced after the intervention (26.7% vs 14.1% p<0.001). Death prior to discharge reduced without reaching statistical significance (14.1% vs10.9%, p=0.195). The rate of cognitive disability reduced in the postintervention cohort (18.8% vs 6.1%, p=0.042). The adjusted ORs (95% CI) for CONS infection, death and cognitive impairment were 0.46 (0.29 to 0.72), 0.73 (0.43 to 1.24) and 0.3 (0.07 to 1.33), respectively. CONCLUSIONS: There appears to be an association between reduced cognitive disability and the implementation of a sepsis reduction bundle. Further study in larger series is required to confirm these findings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: Very low birthweight (VLBW; <1500 g) infants with late-onset sepsis (LOS) have an increased risk of neurodisability. Care bundles to reduce bloodstream infections in neonatal intensive care unit (NICU) are effective in reducing LOS. Our aim was to determine if a sepsis reduction bundle introduced through a quality improvement project would impact neurodevelopmental outcomes in VLBW infants. DESIGN: Cohort study. SETTING: Level 3 regional NICU in the South West of England. PATIENTS: VLBW infants born between 2002 and 2011. INTERVENTIONS: A sepsis reduction care bundle implemented between July 2006 and December 2007. MAIN OUTCOME MEASURES: The primary outcome was risk of coagulase-negative Staphylococcus (CONS) infection diagnosed >3 days of age. Secondary outcomes were death and moderate cognitive impairment. A logistic regression model was derived using the birth era as the independent variable with adjustment for typical confounders. RESULTS: In total, 379 infants were born in the preintervention cohort and 378 in the postintervention cohort. The CONS infection rate was reduced after the intervention (26.7% vs 14.1% p<0.001). Death prior to discharge reduced without reaching statistical significance (14.1% vs10.9%, p=0.195). The rate of cognitive disability reduced in the postintervention cohort (18.8% vs 6.1%, p=0.042). The adjusted ORs (95% CI) for CONS infection, death and cognitive impairment were 0.46 (0.29 to 0.72), 0.73 (0.43 to 1.24) and 0.3 (0.07 to 1.33), respectively. CONCLUSIONS: There appears to be an association between reduced cognitive disability and the implementation of a sepsis reduction bundle. Further study in larger series is required to confirm these findings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Huynh T Trieu; Nguyen Thi Kim Anh; Huynh Ngoc Thien Vuong; T T M Dao; Nguyen Thi Xuan Hoa; Vo Ngoc Cat Tuong; Pham Tam Dinh; Bridget Wills; Phan Tu Qui; Le Van Tan; Lam Minh Yen; Saraswathy Sabanathan; Catherine Louise Thwaites Journal: BMC Infect Dis Date: 2017-09-25 Impact factor: 3.090
Authors: Yu Zhen Lau; Kate Widdows; Stephen A Roberts; Sheher Khizar; Gillian L Stephen; Saima Rauf; Alexander E P Heazell Journal: BMJ Open Qual Date: 2020-04