{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:16:16Z","timestamp":1792149376796,"version":"4.4.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec id=\"ab-poi240030-4\"><jats:title>Importance<\/jats:title><jats:p>The Centers for Disease Control and Prevention plans to introduce hospital-onset bacteremia (HOB) as a health care\u2013associated infection measure. The epidemiology and clinical characteristics of HOB among infants admitted to the neonatal intensive care unit (NICU) are unknown.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240030-5\"><jats:title>Objective<\/jats:title><jats:p>To estimate the rate of HOB among infants admitted to the NICU, measure the association of HOB risk with birth weight group and postnatal age, and estimate HOB-attributable mortality.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240030-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective multicenter cohort study and emulated trial from 2016 to 2021 included a convenience sample of 322 NICUs in the United States. Participants were infants admitted to participating NICUs for 4 or more days.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240030-7\"><jats:title>Exposures<\/jats:title><jats:p>The primary exposures were birth weight and postnatal age. Additional exposures included small for gestational age and central line presence.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240030-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary study outcomes were HOB and HOB-attributable mortality.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240030-9\"><jats:title>Results<\/jats:title><jats:p>Of 451\u202f443 included infants, 250\u202f763 (55.6%) were male, 200\u202f680 (44.4%) were female, and 62\u202f091 (13.8%) were born 1500 g or less. Of 9015 HOB events that occurred among 8356 infants (2%) during 8\u202f163\u202f432 days at risk (unadjusted incidence rate, 1.1 per 1000 patient-days; 95% CI, 1.0-1.2), 4888 HOB events (54.2%) occurred in the absence of a central line. Within the first 2 weeks after birth, the HOB rate was 14.2 per 1000 patient-days (95% CI, 12.6-16.1) among infants born 750 g or less, to 0.4 events per 1000 patient-days among infants born more than 2500 g (95% CI, 0.4-0.5). Among infants born 750 g or less, the relative HOB risk decreased by 90% after day 42 compared with days 4 to 14 (incidence rate ratio [IRR], 0.10; 95% CI, 0.1-0.1). Conversely, among infants born more than 2500 g, the relative HOB risk increased by 50% after day 42 compared with days 4 to 14 (IRR, 1.5, 95% CI, 1.2-1.9). Compared with otherwise similar infants without HOB, infants with HOB had an absolute difference in attributable mortality of 5.5% (95% CI, 4.7-6.3).<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240030-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This study found that HOB events in the NICU are associated with increased mortality. Birth weight is an important risk factor for HOB; however, the relative rate of HOB decreases over postnatal age among low-birth-weight infants and increases among infants born more than 2500 g. Identifying strategies to prevent HOB and programs to decrease HOB risk are urgently needed to reduce infant mortality.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.1840","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T11:07:30Z","timestamp":1719227250000},"page":"792","source":"Crossref","is-referenced-by-count":16,"title":["Hospital-Onset Bacteremia Among Neonatal Intensive Care Unit Patients"],"prefix":"10.1001","volume":"178","author":[{"given":"Erica C.","family":"Prochaska","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"Department of Hospital Epidemiology and Infection Control, Johns Hopkins Health System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoming","family":"Xiao","sequence":"additional","affiliation":[{"name":"Division of Pediatric 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