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Original ArticleOpen Access
Nosocomial Pneumonia in a Newborn Intensive Care Unit
Petdachai W 
Nosocomial pneumonia is a major cause of morbidity and mortality in hospitalized patients.
The risk is especially high in the neonatal intensive care unit (NICU) particularly in infants
with mechanically assisted ventilation. During the 5-year period of the study, 160 infants with
problems including prematurity (60.6%), respiratory distress (55.6%) and birth asphyxia (45.0%)
were admitted to the NICU. One hundred and thirty-three infants (83.1%) received mecha-
nical ventilation. Nosocomial pneumonia was found in 65 infants ( 40.6%) or 88.3 cases per
I ,000 ventilator-days. Low birth weight, prematurity, respiratory distress and hyperbilirubine-
mia were found more significantly in the pneumonia group. They underwent more manipulations
such as the placement of an umbilical catheter and orogastric tube. Infants with pneumonia
received mechanical ventilation at a higher percentage and for a longer period than those without
pneumonia (96.9%
vs
73.7%, odds ratio=ll.2, p=O.OOO) with a mean duration of 11.7 and 3.5 days
respectively (p=O.OOO). The etiologic organisms recovered from hemoculture were
Acinetobacter
calcoaceticus
var.
anitratus
44.0 per cent,
Enterobacter
spp. 16.0 per cent,
Klebsiella pneumoniae
16.0 per cent, coagulase-negative staphylococci 12.0 per cent. There was no concordance of the
bacteriologic results in endotracheal aspirate culture and hemoculture in each infant. Leukocy-
tosis and granulocytosis as well as blood gas values could not differentiate the presence of
pneumonia. The mean hospital stay for the infants with pneumonia was longer (23.0 days
vs
6.4
days, p=O.OOO). Nosocomial pneumonia did not only prolong hospital stay but also contributed
to mortality. Twenty-seven (41.5%) of the infants with pneumonia died, compared with 46 (48.4%)
of the other group without pneumonia (p=0.422). The risk of nosocomial pneumonia can be
reduced by using infection control measures, including meticulous hand washing and gloving
during respiratory manipulation, heat-treated water supply in a nebulizing unit of the ventilator
and proper care of umbilical catheterization.
Key word
: Nosocomial, Pneumonia, Newborn, Intensive Care Unit, NICU
The risk is especially high in the neonatal intensive care unit (NICU) particularly in infants
with mechanically assisted ventilation. During the 5-year period of the study, 160 infants with
problems including prematurity (60.6%), respiratory distress (55.6%) and birth asphyxia (45.0%)
were admitted to the NICU. One hundred and thirty-three infants (83.1%) received mecha-
nical ventilation. Nosocomial pneumonia was found in 65 infants ( 40.6%) or 88.3 cases per
I ,000 ventilator-days. Low birth weight, prematurity, respiratory distress and hyperbilirubine-
mia were found more significantly in the pneumonia group. They underwent more manipulations
such as the placement of an umbilical catheter and orogastric tube. Infants with pneumonia
received mechanical ventilation at a higher percentage and for a longer period than those without
pneumonia (96.9%
vs
73.7%, odds ratio=ll.2, p=O.OOO) with a mean duration of 11.7 and 3.5 days
respectively (p=O.OOO). The etiologic organisms recovered from hemoculture were
Acinetobacter
calcoaceticus
var.
anitratus
44.0 per cent,
Enterobacter
spp. 16.0 per cent,
Klebsiella pneumoniae
16.0 per cent, coagulase-negative staphylococci 12.0 per cent. There was no concordance of the
bacteriologic results in endotracheal aspirate culture and hemoculture in each infant. Leukocy-
tosis and granulocytosis as well as blood gas values could not differentiate the presence of
pneumonia. The mean hospital stay for the infants with pneumonia was longer (23.0 days
vs
6.4
days, p=O.OOO). Nosocomial pneumonia did not only prolong hospital stay but also contributed
to mortality. Twenty-seven (41.5%) of the infants with pneumonia died, compared with 46 (48.4%)
of the other group without pneumonia (p=0.422). The risk of nosocomial pneumonia can be
reduced by using infection control measures, including meticulous hand washing and gloving
during respiratory manipulation, heat-treated water supply in a nebulizing unit of the ventilator
and proper care of umbilical catheterization.
Key word
: Nosocomial, Pneumonia, Newborn, Intensive Care Unit, NICU
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