Effect of early directed implementation of family-integrated care measures on colonisation with Enterobacteriaceae in preterm neonates in NICU

Ülle Parm; Annika Tiit-Vesingi; Hiie Soeorg; Jelena Štšepetova; Kai Truusalu; Sigrid Vorobjov; Irja Lutsar; Tuuli Metsvaht

doi:10.1136/bmjpo-2022-001712

Effect of early directed implementation of family-integrated care measures on colonisation with Enterobacteriaceae in preterm neonates in NICU

BMJ Paediatr Open. 2023 May;7(1):e001712. doi: 10.1136/bmjpo-2022-001712.

Authors

Ülle Parm^#¹, Annika Tiit-Vesingi^#^{2

3}, Hiie Soeorg¹, Jelena Štšepetova¹, Kai Truusalu¹, Sigrid Vorobjov⁴, Irja Lutsar¹, Tuuli Metsvaht^{1

5}

Affiliations

¹ Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.
² Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia annika.tiit-vesingi@itk.ee.
³ Neonatal Intensive Care Unit, East Tallinn Central Hospital, Tallinn, Estonia.
⁴ Department of Risk Behaviour Studies, National Institute of Health Development, Tallinn, Estonia.
⁵ Paediatric and Neonatal Intensive Care Unit, Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.

^# Contributed equally.

Abstract

Background: Hospital-acquired strains (HASs) and multiresistant strains in neonatal intensive care unit often harbour virulence and resistance mechanisms, carrying the risk of invasive infections. We describe colonisation with Enterobacteriaceae in neonates receiving early directed versus routine family-integrated care (FIC) within the first month of life.

Methods: A prospective cohort study included neonates with a gestational age below 34 weeks. During the first period, neonates were admitted to an open bay unit with transfer to the single-family room if available; feeding with the mother's own breast milk (MOBM) was introduced within 24 hours, and skin-to-skin contact (SSC) within 5 days of life (the routine care group). During the second period, following a wash-in of 2 months, care in a single-family room within 48 hours, the introduction of MOBM within two and SSC in 48 hours were applied (the intervention group). Enterobacteriaceae isolated from neonatal stool, breast milk and parental skin swabs were genotyped, Simpson's Index of Diversity (SID) calculated, and extended-spectrum beta-lactamases (ESBL) detected.

Results: In 64 neonate-parents' groups, 176 Enterobacteriaceae, 87 in routine care and 89 in the intervention group were isolated; 26 vs 18 were HAS and one vs three ESBL positive, respectively. In the intervention group compared with the routine care group, SSC and MOBM feeding was started significantly earlier (p<0.001); during the first week of life, time spent in SSC was longer (median hours per day 4.8 (4-5.1) vs 1.9 (1.4-2.6), p<0.001) and the proportion of MOBM in enteral feeds was higher (median (IQR) 97.8% (95.1-100) vs 95.1% (87.2-97.4), p=0.011). Compared with the routine care group, the intervention group had higher SID and a reduction of HAS by 33.1% (95% CI 24.4% to 42.4%) in time series analysis.

Conclusions: Early implementation of FIC measures may hold the potential to increase diversity and reduce colonisation with HAS Enterobacteriaceae.

Keywords: Microbiology; Neonatology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delivery of Health Care, Integrated*
Enterobacteriaceae / genetics
Enterobacteriaceae Infections* / therapy
Female
Humans
Infant
Infant, Newborn
Intensive Care Units, Neonatal
Prospective Studies