Antimicrobial therapy utilization in neonates with hypoxic-ischemic encephalopathy (HIE): a report from the Children's Hospital Neonatal Database (CHND)

J Perinatol. 2020 Jan;40(1):70-78. doi: 10.1038/s41372-019-0527-2. Epub 2019 Oct 14.

Abstract

Objective(s): Quantify antimicrobial therapy (AMT) use in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia (HIE/TH).

Study design: Newborns with HIE/TH were identified from the Children's Hospital Neonatal Database (CHND). Early infection (onset ≤7 days of life) was defined as "confirmed" (culture proven) or "suspected infection" (culture negative but treated) and compared with a "no infection" group.

Results: 1501/1534 (97.8%) neonates received AMT. 36 (2.3%) had confirmed, 255 (16.6%) suspected, and 1243 (81.0%) had no infection. The median (IQR) AMT duration was 13 (8-21), 8 (7-10), and 3 (3-7) days for the three groups, respectively (p < 0.001). AMT duration of use varied significantly across centers, adjusted for covariates (OR 1.88, 95% CI: 1.43-2.46).

Conclusion(s): Incidence of early confirmed infection in neonates with HIE/TH (23/1000) is significantly higher than reported rates of early onset sepsis in term and near term infants (0.5-1.0/1000 live births). Antimicrobial-stewardship opportunities exist in infants with negative cultures.

MeSH terms

  • Anti-Infective Agents / therapeutic use*
  • Brain / diagnostic imaging
  • Brain / pathology
  • Databases, Factual
  • Female
  • Hospitals, Pediatric
  • Humans
  • Hypothermia, Induced*
  • Hypoxia-Ischemia, Brain / complications
  • Hypoxia-Ischemia, Brain / diagnostic imaging
  • Hypoxia-Ischemia, Brain / drug therapy*
  • Hypoxia-Ischemia, Brain / therapy
  • Infant, Newborn
  • Infections / complications
  • Magnetic Resonance Imaging
  • Male

Substances

  • Anti-Infective Agents