Bundles to Prevent Neonatal Ventilator Associated Pneumonia in Neonatal Intensive Care Unit

El Sheikh, Abdel-razek Hefni; Al Banaa, Ehab Abdelmoniem; Ismail Ibrahim, Yasser Ahmed; Mahrous, Haytham Kamal Ahmed

doi:10.21608/zumj.2025.405721.4061

Bundles to Prevent Neonatal Ventilator Associated Pneumonia in Neonatal Intensive Care Unit

Document Type : Original Article

Authors

¹ Professor of Pediatrics Department, Faculty of Medicine, Zagazig university, Egypt

² Pediatrics Department, Faculty of Medicine, Zagazig University, Egypt

³ Lecturer of Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt

10.21608/zumj.2025.405721.4061

Abstract

Background: Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection in neonates receiving mechanical ventilation in NICUs, increasing morbidity, mortality, and hospital stay durations. This study aimed to determine the impact of ventilator bundles of care practices on the rates of VAP in mechanically ventilated neonates. Methods: This randomized controlled trial study on 98 neonates requiring mechanical ventilation for ≥48 hours were randomly allocated into two equal groups. The bundle group received a VAP preventive care bundle including reinforced hand hygiene, 45° head elevation, left lateral positioning, oral care with chlorhexidine, ventilator circuit care, early weaning, and prevention of accidental extubation. The conventional group received routine infection control measures. Clinical, radiological, and laboratory data including complete blood count, arterial blood gases, C-reactive protein, and endotracheal aspirate cultures were collected. Results: During follow-up, the conventional group exhibited significantly worse clinical and ventilator parameters, with higher rates of new chest findings. Peak inspiratory pressure, respiratory rate, and FiO2 were significantly elevated compared to the bundle group. VAP incidence was markedly higher in the conventional group (30.6%) versus the bundle group (8.2%). Additionally, mechanical ventilation duration and hospital stay were significantly prolonged in the conventional group. Kaplan-Meier survival analysis revealed better outcomes in the bundle group, with 100% survival versus a 12.2% mortality rate in the conventional group. Conclusion: Implementing a VAP preventive bundle significantly reduced VAP incidence, improved respiratory and clinical outcomes, and enhanced survival in mechanically ventilated neonates.

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