Risk factors for nosocomial infections in critically ill newborns: A 5-year prospective cohort study

Background: Nosocomial infections (NIs) are one of the most important causes of morbidity in neonatal intensive care units (NICUs). The aim of this study was to identify risk factors (RFs) for NIs among critically iii newborn patients in a Brazilian NICU. Methods: This 5-year prospective cohort study in an 8-bed NICU included all, infants born in the hospital and admitted to the NICU from 1993 to 1997. Exposure variables were maternal and newborn data prospectively collected from patient records. Univariate: and multivariate analyses were used to determine independent RFs associated with NIs. Results: Univariate analysis indicated gestational age, congenital abnormality, premature rupture of membranes, maternal illness, birth weight, mechanical ventilation, central venous catheter, total parenteral nutrition, peripheral venous catheter, and length of stay as possible RFs. Multivariate analysis identified 5 independent RFs for NIs: premature rupture of membranes (hazard ratio [HR] = 1.51 [95% CI. 1.15-1.99]), maternal disease (HR = 1.57 [95% CI. 1.18-2.07]), mechanical ventilation (HR = 2.43 [95% CI, 1.67-3.53]), central venous catheter (HR = 1.70 [95% CI, 1.21-2.41]), and total parenteral nutrition (HR = 4.04[95% CI. 2.61-6.25]). Conclusions : The recognition of RFs for NIs is an important tool for the identification and development of interventions to minimize such risks in the NICU.