409 - Practice Variation in the management of Ventilator Associated Pneumonia (VAP) in Neonatal Intensive Care Units: A Physician Survey

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 409
Publication Number: 409.334

irfan Shehzad, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Muppala Raju, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Gueorgui Dubrocq, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Kirstine Sepulveda, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Malvika sagar, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Niraj Vora, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States

Presenting Author(s)

irfan Shehzad, MD

Fellow
Baylor Scott White McLane Children's Medical Center
Temple, Texas, United States

Background: VAP generally refers to bacterial infection of the lungs in an intubated patient. It is a common type of healthcare associated infection. Infants in the NICU are vulnerable to VAP that increases their morbidity and mortality. There is a significant overlap of clinical features of VAP with other pulmonary pathologies particularly in preterm infants which can make the definitive diagnosis and management of neonatal VAP challenging.

Objective:

The aim of this study was to measure the practice variation and knowledge among neonatal intensive care unit providers regarding the diagnosis and management of VAP.

Design/Methods:

REDCap (Research Electronic Data Capture) survey was emailed to the practicing members (Neonatologists, NICU fellows and Advance practice providers) of the Section on Neonatal-Perinatal Medicine (SoNPM) of American academy of pediatrics (AAP) and Pediatrix Medical Group. We used descriptive statistics to analyze the data from the respondents.

Results:

Of 254 respondents; 87% were neonatologist,98% were from level III and IV NICU, 54% reported having VAP prevention guideline, 46 % were either unsure or didn’t have guideline in their units.77% reported ordering respiratory culture as part of sepsis work up,16% for a potential source of CLABSI and 5% for routine surveillance. 88% stated using Tracheal aspirate technique to collect specimen. Reasons reported for obtaining respiratory culture were; change in character of tracheal secretions (81%), increase in infiltrates on chest X-ray (79%), increase in respiratory secretions (72%), increase in oxygen requirement (59%), worsening of gas exchange (53%). 52% reported establishing a diagnosis of VAP, 28% pneumonia and 10% tracheitis based on positive respiratory culture. 73% stated relying on type of bacteria rather than bacteria burden to start treatment,72% described prescribing IV Gentamicin and 42% IV Vancomycin. 57% would treat positive respiratory culture for a maximum of 7 days, 19% for 5 days and only 12% for 10 days. The reported intradepartmental variation on when to obtain respiratory culture and prescribe antibiotics was 50% and 39% respectively.

Conclusion(s): VAP remains an enigmatic clinical entity with a significant variation in its management. Efforts are needed to expand the studies in order to develop consensus to follow guidelines among providers to effectively prevent, diagnose and treat neonatal VAP.