Table 3.

Systematic review: Overview of incidence, diagnostic criteria, risk factors and treatment.

Source	Study design, (No of patients)	Neonatal VAP incidence	Diagnostic criteria	Risk factors	Treatment
Afjeh et al. (27) Iran	Prospective cohort study (81 patients)	11.6 VAP/1,000 ventilator-days	CDC guidelines for infants ≤ 1 year old	Independent risk factors: Purulent sputum, longer duration of mechanical ventilation, antacid therapy	Not specified
Apisarnthanarak et al. (28) USA	Prospective cohort study (229 patients)	4–6.5 VAP/1,000 ventilator-days	CDC guidelines for infants ≤ 1 year old	Independent risk factors: Prior bloodstream infection, longer duration of mechanical ventilation (marginally significant)	Not specified
Azab et al. (8) Egypt	Prospective cohort study (143 patients)	73 VAP episodes	Foglia et al. (29)	Not specified	Not specified
Badr et al. (30) Egypt	Prospective observational study (56 patients)	32 VAP episodes	CPIS (clinical pulmonary infection score)	Longer duration of mechanical ventilation, low gestational age, low birth weight	Not specified
Cernada et al. (1) Spain	Prospective observational study (198 patients)	10.9 VAP/1,000 ventilator-days	CDC guidelines for infants ≤ 1 year old + positive BAL (BAL with blind protected catheter to diminish contamination)	Independent risk factor: Days of mechanical ventilation Others: Days of oxygen, times of reintubations, numbers of transfusions, previous bloodstream infection, enteral feeding, low gestational age, low birth weight, female sex	Not specified
Deng et al.(31) China	Case-control study (349 patients)	25.6 VAP/1,000 ventilator-days	At least 3 of the following: temperature instability OR new onset of purulent sputum, change in character of sputum, increased respiratory secretions, increased suctioning OR leukocytes >10x10E9 cells/l, < 3x10E9 cells/l OR two or more abnormal chest X-rays OR apnea, tachypnea, nasal flaring, grunting [Adapted Foglia et al.(29)]	Independent risk factors: Low birth weight, neonate respiratory distress syndrome, parenteral alimentation, reintubation (>3x), mechanical ventilation ≥ 7 days Others: Age < 3d, gestational age < 37 weeks, Bronchopulmonary dysplasia, previous blood stream infection, hypoxic ischemic encephalopathy, frequent drawing of blood, bronchoscopy	Cephalosporin 61.2%, Penicillin derivatives 45.5%, Aminoglycosides 13.4%, Metronidazole 20.1%, Macrolides 11.2%, Quinolones 17.8%, Vancomycin 11.6%, Sulfa derivatives 8.1%, Antifungal agents 8.9%, Antiviral agents 8.6% Duration: 5.4 ± 3.2 days
Fallahi et al. (32) Iran	Prospective cross-sectional study (66 patients)	22 VAP episodes	Modified CDC guidelines for infants ≤ 1 year old	Lower gestational age, lower birth weight, longer duration of hospital stay, prolonged ventilator need	Not specified
Katayama et al. (33) Japan	Prospective study	49 VAP episodes	Increased ventilator demand with increased amount of endotracheal aspirate + microorganisms and polymorphonuclear leukocytes in gram-stained smears of aspirates + increased CRP and/or intracellular bacteria on gram-stained smears	Not specified	Immediate gram-staining and examination of sputum aspirates by a neonatal physician: - Gram-negative bacilli: Piperacillin or Piperacillin + Amikacin - Gram-positive cocci: Vancomycin
Kawanishi et al. (34) Japan	Retrospective observational study (71 patients)	14 VAP episodes	Foglia et al. (29)	Low birth weight (esp. < 626g), times of ventilator tube changes, longer duration of mechanical ventilation	Not specified
Khattab et al. (35) Egypt	Not specified (85 patients)	47 VAP episodes (55.2%)	CDC guidelines	Prematurity, low birth weight, longer duration of mechanical ventilation	Not specified
Lee et al. (36) Taiwan	Retrospective observational study (114 patients)	7.1 VAP/1,000 ventilator-days	CDC guidelines for infants ≤ 1 year old	Longer duration of mechanical ventilation, longer parenteral nutrition, low gestational age, low birth weight	Not specified
Murila et al. (37) Australia	Retrospective study (124 patients)	74 positive ETA cultures, 58 VAP episodes	Positive culture of endotracheal secretion + overall condition + change in respiratory status (increased FiO2, increased ventilator support, new infiltrate on Chest X-ray)	Not specified	Treatment: Vancomycin + Imipenem
Petdachai (38) Thailand	Prospective observational study (170 patients)	70.3 VAP/1,000 ventilator-days	Modified CDC guidelines for infants ≤ 1 year old	Independent risk factors: Umbilical catheterization, respiratory distress syndrome, orogastric tube Others: Lower birth weight, longer duration of mechanical ventilation, longer hospital stay	Not specified
Thatrimontrichai et al. (39) Thailand	Prospective cohort study (128 patients)	10.1 VAP/1,000 ventilator-days	CDC guidelines for infants ≤ 1 year old	Independent risk factors: Birth weight < 750g, sedative medication Others: Reintubation rate, antihistamine use	Not specified
Tripathi et al. (40) India	Prospective observational study (98 patients)	37.2 VAP/1,000 ventilator-days	CDC guidelines for pediatric patients	Independent risk factors: Longer duration of mechanical ventilation, very low birth weight Others: Prematurity, numbers of reintubation, length of NICU stay	Not specified
Yuan et al. (41) China	Retrospective cohort study (259 patients)	52 VAP episodes	New and persistent radiographic evidence of focal infiltrate Plus 2 of the following: fever >38°C, leukocytes >12x10E9 cells/l, purulent sputum No hyaline membrane disease, meconium aspiration, atelectasis as possible diagnosis	Independent risk factors: Reintubation, longer duration of mechanical ventilation, treatment with opiates, endotracheal suctioning Others: transfusion, parenteral nutrition	Not specified
Van der Zwet et al. (23) The Netherlands	Retrospective surveillance study (742 patients)	5.8 - 19.7 (mean 11.8) VAP/1,000 ventilator days (depending on birth weight)	Modified CDC guidelines for infants ≤ 1 year old	Mechanical ventilation, low birthweight	Not specified