Incidence of septicemia immediately after elective gastrointestinal contrast procedures in infants: a cohort study
Received 1 April 2009; received in revised form 20 June 2009; accepted 6 July 2009.
Abstract
Background
Sepsis is a documented complication of gastrointestinal contrast procedures in neonates. However, the identification of preventive measures is hampered by a lack of data on its incidence and risk factors.
Methods
The study used a retrospective cohort analysis of infants with selected surgical gastrointestinal conditions admitted to a tertiary neonatal center. Risk factors were identified by logistic regression and matched case-control analyses. Contrast procedure-related bacteremia or sepsis were defined by clinical signs with or without a positive blood culture, respectively, within 48 hours after an intervention.
Results
The apparent incidence of contrast procedure-related sepsis was 2.7 per 100 infant procedures. Infants with contrast procedure-related sepsis were also generally of lower gestational age and birth weight and generally sicker (ie, higher incidence of hepatic cholestatic disease, and poorer weight gain). Notably, all infants with contrast procedure-related sepsis previously had necrotizing enterocolitis. Although the number of cases of sepsis directly attributable to the procedures may be lower, as suggested by a comparison with the baseline time prevalence of bacteremia in this cohort, significant associated morbidities and mortality were observed.
Conclusions
This is the first study reporting the incidence of contrast procedure-related sepsis in high-risk infants with surgical gastrointestinal conditions. Based on our observations, the routine use of prophylactic antibiotics to prevent this complication in this population does not seem warranted.
aChildren's and Women's Health Center of British Columbia, Vancouver, British Columbia, Canada V6H 3V4
bDepartment of Radiology, Children's and Women's Health Center of British Columbia, Vancouver, British Columbia, Canada V6H 3V4
cDepartment of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
dChild and Family Research Institute, Vancouver, British Columbia, Canada V5Z 4H4
Corresponding author. Children's and Women's Health Center of British Columbia, Vancouver, British Columbia, Canada V6H 3V4. Tel.: +1 604 875 2135; fax: +1 604 875 3106.
ABSTRACT