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Extracorporeal membrane oxygenation and bloodstream infection in congenital diaphragmatic hernia

Journal of Perinatology volume 39, pages 1384–1391 (2019)Cite this article

Subjects

Abstract

Objective

To characterize the risk of bloodstream (BSI) and urinary tract infection (UTI) and describe antibiotic use in infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO).

Study design

The Children’s Hospitals Neonatal Database was queried for infants with CDH and ECMO treatment from 2010 to 2016. The outcomes included BSI, UTI, and antimicrobial medication. Member institutions completed a survey on infection practices.

Result

Eighteen of the 338 patients identified (5.3%) had ≥1 BSI during their ECMO course. The likelihood of BSI increased with time: 1.2/1000 ECMO days; 0.6% (2/315) in the first week and rising to 14.6/1000; 8.6% (5/58) after 21 days (p = 0.002). More than 95% of patients received antibiotics each week on ECMO.

Conclusions

Confirmed BSI is rare in infants with CDH treated with ECMO in the first week, but increases with the duration of ECMO. Use of antibiotics was extensive and did not correspond to infection frequency.

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Acknowledgements

JA, DD (ex officio), FD (ex officio), JE, KM, MP, EP, TG, and BB, and AP, KR, and BS are members of the Children’s Hospitals Neonatal Consortium, Inc. (www.thechnc.org). For more information, please contact: support@thechnc.org. We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND). The site sponsors/contributors for the CHND are also included.

Children’s Hospitals Neonatal Consortium’s (CHNC) Congenital Diaphragmatic Hernia Focus Group

Jeanette Asselin, David Durand (ex officio), Francine Dykes (ex officio), Jacquelyn Evans, Karna Murthy, Michael Padula, Eugenia Pallotto, Theresa Grover, Beverly Brozanski, and Anthony Piazza, Kristina Reber and Billie Short are members of the Children’s Hospitals Neonatal Consortium, Inc., (site: thechnc.org). For more information, please contact: support@thechnc.org

We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database (CHND). The site sponsors/contributors for the CHND are also included:

Children's Healthcare of Atlanta, Atlanta, GA (Francine Dykes, Anthony Piazza); Children’s Healthcare of Atlanta at Scottish Rite (Gregory Sysyn); Children’s Hospital of Alabama, Birmingham, AL (Carl Coghill, Allison Black); Le Bonheur Children’s Hospital, Memphis, TN (Ramasubbareddy Dhanireddy); Children’s Hospital Boston, Boston, MA (Anne Hansen, Tanzeema Houssain); Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia); Cincinnati Children’s Hospital, Cincinnati, OH (Beth Haberman, Brenda Poindexter, Amy Nathan, Kristin Nelson, Paul Kingma, Stefanie Riddle, Stephanie Merhar, Heather Kaplan); Nationwide Children’s Hospital, Columbus, OH (Kristina Reber); Children's Medical Center, Dallas, TX (Rashmin Savani, Luc Brion, Noorjahan Ali); Children’s Hospital Colorado, Aurora, CO (Theresa Grover); Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan); Cook Children’s Health Care System, Fort Worth, TX (Jonathan Nedrelow, Annie Chi, Yvette Johnson); Texas Children's Hospital, Houston, TX (Gautham Suresh); Riley Children’s Hospital, Indianapolis, IN (William Engle, Lora Simpson, Gregory Sokol); Children’s Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto); Arkansas Children's Hospital, Little Rock, AR (Robert Lyle, Becky Rogers); Children’s Hospital Los Angeles, Los Angeles, CA (Steven Chin, Rachel Chapman); American Family Children’s Hospital, Madison, WI (Jamie Limjoco, Lori Haack); Children's Hospital & Research Center Oakland, Oakland, CA (David Durand, Jeanette Asselin, Art D’Harlingue, Priscilla Joe) ; The Children's Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula, David Munson); St. Christopher’s Hospital for Children, Philadelphia, PA (Suzanne Touch); Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Beverly Brozanski); St. Louis Children's Hospital, St Louis, MO (Tasmin Najaf, Rakesh Rao, Amit Mathur); All Children's Hospital, St. Petersburg, FL (Victor McKay); Rady Children’s Hospital, San Diego, CA (Mark Speziale, Brian Lane, Laural Moyer); Children's National Medical Center, Washington, DC (Billie Short); AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan); Primary Children’s Medical Center, Salt Lake City, UT (Con Yee Ling, Shrena Patel); Children’s Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta); Children’s Hospital of Omaha (Lynne Willett, Nicole Birge); Florida Hospital for Children (Rajan Wadhawan); Seattle Children’s Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert DiGeronimo, Zeenia Billimoria); Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee); Children’s Hospital Orange County, Los Angeles, CA (Michel Mikhael, Irfan Ahmad).

Author information

Authors and Affiliations

  1. Children’s Healthcare of Atlanta at Egleston and Emory University School of Medicine, Atlanta, GA, USA

    Sarah Keene

  2. Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA

    Theresa R. Grover & Jason Gien

  3. Ann & Robert H. Lurie Children’s Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Karna Murthy & Nicolas F. M. Porta

  4. Children’s Mercy Hospital and University of Missouri, Kansas City, MO, USA

    Eugenia K. Pallotto

  5. Children’s Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Beverly Brozanski

  6. Children’s Hospital Association, Overland Park, KS, USA

    Isabella Zaniletti

  7. Cook Children’s Hospital, Fort Worth, TX, USA

    Yvette R. Johnson

  8. Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA

    Ruth B. Seabrook

  9. Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA

    Beth Haberman

  10. Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA, 98195, USA

    Robert DiGeronimo

  11. Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Natalie Rintoul

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  1. Sarah Keene
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Consortia

on behalf of the Children’s Hospitals Neonatal Consortium’s (CHNC) Congenital Diaphragmatic Hernia Focus Group

Corresponding author

Correspondence to Sarah Keene.

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Conflict of interest

The authors have no competing financial interests to declare in relation to the work described. The authors have no sources of funding to report for this work. One author, KM is a member and Chair of the Board of the Childrens’ Hospital Neonatal Consortium (CHNC), a 501-3-c organization. Other than statistical support and consultation, the Childrens’ Hospital Association (CHA) had no input in the design of the project, the aims, or the decision whether to submit this paper for publication. The remaining authors delare that they have no conflicts of interest.

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Members of the Children’s Hospitals Neonatal Consortium’s (CHNC) Congenital Diaphragmatic Hernia Focus Group are listed below the Acknowledgements.

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Keene, S., Grover, T.R., Murthy, K. et al. Extracorporeal membrane oxygenation and bloodstream infection in congenital diaphragmatic hernia. J Perinatol 39, 1384–1391 (2019). https://doi.org/10.1038/s41372-019-0435-5

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