According to researchers, bloodstream infections are a leading cause of death among infants admitted to the neonatal intensive care unit (NICU). The Centers for Disease Control and Prevention (CDC) collects and reports rates of central line-associated blood stream infections, or “CLABSIs,” — which are bloodstream infections associated with catheters. However, CLABSIs only represent a portion of neonatal bloodstream infections in hospitalized patients. The CDC has proposed a new surveillance measure — hospital-onset bacteremia (HOB), a positive blood culture on or after the fourth day of hospital admission, to broaden surveillance for health care-associated bloodstream infections. 

In an effort to highlight this new quality measure, a group of researchers from Johns Hopkins Children’s Center performed a study, published June 24 in JAMA Pediatrics, to estimate the incidence, clinical risk factors and mortality rate of HOB among infants admitted to NICUs.  

In their study, researchers examined 451,443 infants admitted to more than 300 NICUs between 2016 and 2021. Findings from the study show that HOB in the NICU predominantly affects infants who weigh 1.7 pounds or less in the first several weeks after birth, and is associated with a 5.5% increase in risk of death as compared to similar infants without HOB. While birth weight is an important risk factor for HOB, the rate decreases after birth among low-birth weight infants and increases among infants who weigh more than 5.5 pounds at birth.

Aaron Milstone, M.D., M.H.S., and Erica Prochaska, M.D., pediatric infectious diseases specialists at Johns Hopkins Children’s Center, and their investigative team believe there is an urgent need to identify strategies and programs to prevent and decrease HOB risk in NICUs across the U.S. to help prevent death in infants. The researchers believe these findings can inform the practice of monitoring HOB among infants as a national quality and safety measure and a benchmark for infection prevention.