Ventilator-Associated Pneumonia in Neonates: An Update

Health-care–associated infections affect neonatal morbidity and mortality, as well as length of stay and hospital costs. Ventilator-associated pneumonia (VAP) accounts for 6.8% to 32.2% of these infections. Low birthweight, duration of mechanical ventilation, opiate treatment for sedation, frequent suctioning, and reintubation have all been shown to increase the risk of VAP. Both Gram-positive and Gram-negative organisms that originate from endogenous or exogenous sources are responsible for VAP. Accurately diagnosing VAP in neonates is challenging because procedures such as tracheal aspirate culture and Gram-stain have low sensitivity, specificity, and positive predictive value. Although several authors have shown that bronchial aspirates through nonbronchoscopic bronchoalveolar lavage improve diagnostic accuracy, further studies are needed to investigate the diagnostic value and safety profile of these procedures. Very few randomized trials have been conducted in neonates to evaluate methods to prevent VAP, and thus most neonatal VAP prevention recommendations are based on adult trials. This review summarizes the epidemiology, pathogenesis, diagnosis, and treatment of VAP and touches on a number of practical steps to prevent VAP in neonates.