A Observational Study on Ventilator-associated Pneumonia as a Risk for Nosocomial Infection in Mechanically Ventilated Neonates In NICU of Assiut University Children Hospital PROTOCOL OF THESIS Descriptive Study

Background:

Neonatal deaths represent third of the global burden of child mortality [1]. In Egypt, Infections such as pneumonia, meningitis, sepsis/septicemia and other infections account for 28% of deaths during the neonatal period, Survival cannot be achieved without substantial reductions in infection-specific neonatal mortality [2]. Neonatal sepsis is usually classified as early or late onset sepsis. Early sepsis occurs within the first 72 hours of birth and late neonatal sepsis occurs after 72 hours of birth. Early neonatal sepsis is associated with acquisition of microorganism from mother Late neonatal sepsis usually occurs due to the lack of aseptic working conditions [3]. The occurrence of late sepsis is considered an important indicator of quality of care. Mechanical ventilation is an essential, life-saving therapy for patients with critical illness and respiratory failure. These patients are at high risk for complications and poor outcomes, including death, Ventilator-associated pneumonia (VAP), Sepsis, pulmonary embolism, barotrauma, and pulmonary edema. Such complications can lead to longer duration of mechanical ventilation, longer stays in the intensive care unit (ICU) and hospital, increased healthcare costs, and increased risk of disability and death [4, 5]. Ventilator associated pneumonia (VAP) is defined as a nosocomial lower airway infection, i.e. pneumonia, in intubated patients with onset after 48 h or more of invasive mechanical ventilation [6]. VAP is usually caused by airway colonization by potential pathogens; Sources of airway colonization can be the patient's own flora, i.e., bacterial overgrowth in oral secretions, reflux and aspiration of gastric fluid or the patient's environment with its caretakers and equipment [7, 8].

Mechanically ventilated babies face a particular risk because artificial airways bypass the body's defenses against inhaled pathogens and offer new routes for non-air borne pathogens. Intubation associated lesions of pharynx and trachea lead to bacterial colonization by the deterioration of the swallowing reflex and the ciliary functions [9].VAP is one of the most frequently diagnosed nosocomial infections [10] and, after suspected early onset sepsis, second most reason for antibiotic intervention in Neonatal Intensive Care Unit (NICU) [11, 12].VAP incidence can be reduced by infection control measures such as VAP-prevention-bundles [13]. Regarding diagnosis of VAP episode requires a combination of radiological, clinical, and laboratory criteria. However Center for Disease Control and Prevention/ National Nosocomial Infection Surveillance (CDC/NNIS) criteria refers to infants younger than 1 year and do not define specific criteria for the newborn period in term or preterm infants. In spite of this lack of specificity, most studies of VAP performed in NICUs are based on these criteria [14].

Keywords: Newborn, Mechanical ventilation, ventilator-associated pneumonia, risk factors, causative organisms.

'Method's: Design: A prospective, observational cohort surveillance, was carried out at our Neonatal Intensive Care Unit (NICU) was done during a period from April 2018 to March 2019 to neonates who needed mechanical ventilation, reviewing data of diagnosis of neonates with ventilation associated pneumonia used .