Nbsi
We studied
the effect of the use of antenatal steroid treatment on the incidence of nosocomial bloodstream infections (NBSI). All episodes of
culture proven NBSI occurring after 96 h of hospitalisation
were identified retrospectively during a 10-year period (1991-2001). Throughout
the study period, the use of antenatal steroids, demographic characteristics
and morbidity of the patients were recorded prospectively. Since 1996 more
efforts were made to use antenatal steroids to decrease neonatal morbidity and
mortality. The incidence rates of NBSI were compared between period 1
(1991-1995) and period 2 (1996-2001). The overall incidence rate of NBSI
dropped significantly from 7.4% (6.1%-8.9%) in period 1 to 5.0% (4.0%-6.2%) in
period 2 and was most pronounced in the birth weight category 1000 g-1500 g
(11.7%, 7.9%-15.0% to 6.9%, 4.3%-10.5%) and 1500 g-2500 g (3.6%, 2.2%-5.6% to
1.4%, 0.6%-2.8%). Antenatal use of steroids increased overall from 19% in 1991
to 51% in 2001 ( P<0.001). Since 1996 there was a
decreasing number of ventilation days ( P=0.011) and
decreasing incidence of patent ductus arteriosus ( P=0.001), while the incidence of neonatal
surgery, chronic lung disease and duration of hospitalisation
remained constant over time. Conclusion: increased use of antenatal steroids is
associated with a decreasing incidence rate of nosocomial
bloodstream infections in neonates with birth weights between 1000 g and 2500
g, probably by decreasing the incidence of patent ductus
arteriosus and/or due to improved respiratory
outcome. This finding needs to be confirmed by randomised
control trials or by a large prospective cohort study in similar population
groups.
PMID: 14730446 [PubMed - in process]