{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:40:48Z","timestamp":1792701648493,"version":"4.5.0"},"reference-count":74,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To assess preventive strategies for ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, and Cochrane Library were searched in June 2025. Eligible studies evaluated primary VAP-prevention interventions in neonates receiving MV. Outcomes included odds ratios (ORs), incidence rate ratios (IRRs), and incidence rate differences (IRDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-four studies involving 6,301 neonates were included. Bundle-based quality-improvement packages were associated with lower VAP occurrence (OR\u2009=\u20090.40, 95% CI 0.28\u20130.57; I\u00b2 = 37%). MV-adjusted analyses showed lower incidence (IRR\u2009=\u20090.56, 95% CI 0.43\u20130.73) and 8.33 fewer VAP cases per 1000 MV-days (IRD = \u20130.0083, 95% CI \u20130.0127 to \u20130.0039). Oral care was associated with lower VAP odds (OR\u2009=\u20090.53, 95% CI 0.35\u20130.81; I\u00b2 = 3%). Evidence for other interventions was limited and heterogeneous.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bundle-based quality-improvement packages were associated with lower neonatal VAP rates, although heterogeneous bundle composition and non-randomized designs limit causal interpretation. Oral care was also associated with lower VAP odds, but confidence in the magnitude of effect is limited by small-study effects, inconsistent subgroup findings, and variable diagnostic criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>This study provides the most comprehensive synthesis to date focused exclusively on VAP in ventilated neonates, incorporating ventilator-day\u2013adjusted outcomes.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>By using robust meta-analytic methods across diverse study designs, it clarifies which interventions have consistent evidence and which remain uncertain.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Bundle-based quality-improvement packages were associated with meaningful relative and absolute reductions in neonatal VAP.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The findings support further evaluation and implementation of bundle-based quality-improvement strategies.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Uncertainty regarding the magnitude of benefit from oral care and the need for higher-quality controlled studies.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41390-026-05562-8","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:11:35Z","timestamp":1792656695000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary preventive interventions to reduce ventilator-associated pneumonia in neonatal intensive care units: a meta-analysis"],"prefix":"10.1038","author":[{"given":"Ibrahim","family":"Elmakaty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Karen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Kokash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor Faisal","family":"Al-Sayegh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled Mousa","family":"Bacha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Abdelhady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Gad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"5562_CR1","doi-asserted-by":"publisher","first-page":"909217","DOI":"10.3389\/fped.2022.909217","volume":"10","author":"VR Rangelova","year":"2022","unstructured":"Rangelova, V. R., Raycheva, R. D., Kevorkyan, A. K., Krasteva, M. B. & Kalchev, Y. I. Ventilator-associated pneumonia in neonates admitted to a tertiary care NICU in Bulgaria. Front. Pediatr. 10, 909217 (2022).","journal-title":"Front. Pediatr."},{"key":"5562_CR2","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s00431-014-2278-6","volume":"173","author":"B Tan","year":"2014","unstructured":"Tan, B. et al. Risk factors for ventilator-associated pneumonia in the neonatal intensive care unit: a meta-analysis of observational studies. Eur. J. Pediatr. 173, 427\u2013434 (2014).","journal-title":"Eur. J. Pediatr."},{"key":"5562_CR3","doi-asserted-by":"crossref","unstructured":"Rangelova, V., Kevorkyan, A., Raycheva, R. & Krasteva, M. Ventilator-associated pneumonia in the neonatal intensive care unit-incidence and strategies for prevention. Diagnostics 14, 240 (2024).","DOI":"10.3390\/diagnostics14030240"},{"key":"5562_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-06673-9","volume":"21","author":"H-C Wang","year":"2021","unstructured":"Wang, H.-C. et al. Clinical characteristics and outcomes of neonates with polymicrobial ventilator-associated pneumonia in the intensive care unit. BMC Infect. Dis. 21, 965 (2021).","journal-title":"BMC Infect. Dis."},{"key":"5562_CR5","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1007\/s12519-017-0010-0","volume":"13","author":"A Thatrimontrichai","year":"2017","unstructured":"Thatrimontrichai, A. et al. Outcomes and risk factors of ventilator-associated pneumonia in neonates. World J. Pediatr. 13, 328\u2013334 (2017).","journal-title":"World J. Pediatr."},{"key":"5562_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-1062-1","volume":"15","author":"SF Azab","year":"2015","unstructured":"Azab, S. F. et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using \u201cVap Prevention Bundle\u201d: a cohort study. BMC Infect. Dis. 15, 314 (2015).","journal-title":"BMC Infect. Dis."},{"key":"5562_CR7","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1002\/jpen.1601","volume":"44","author":"M Abd-Elgawad","year":"2020","unstructured":"Abd-Elgawad, M., Eldegla, H., Khashaba, M. & Nasef, N. Oropharyngeal administration of mother\u2019s milk prior to gavage feeding in preterm infants: a pilot randomized control trial. JPEN J. Parenter. Enter. Nutr. 44, 92\u2013104 (2020).","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"5562_CR8","doi-asserted-by":"crossref","unstructured":"Chu, S. M. et al. One-week versus 2-day ventilator circuit change in neonates with prolonged ventilation: cost-effectiveness and impact on ventilator-associated pneumonia. Infect. Control Hosp. Epidemiol. 36, 287\u2013293 (2015).","DOI":"10.1017\/ice.2014.48"},{"key":"5562_CR9","doi-asserted-by":"publisher","first-page":"2947","DOI":"10.1080\/14767058.2017.1359826","volume":"31","author":"Z Ezzeldin","year":"2018","unstructured":"Ezzeldin, Z. et al. Nebulized hypertonic saline to prevent ventilator associated pneumonia in premature infants, a randomized trial. J. Matern. Fetal. Neonatal. Med. 31, 2947\u20132952 (2018).","journal-title":"J. Matern. Fetal. Neonatal. Med."},{"key":"5562_CR10","first-page":"607","volume":"31","author":"RM Ryan","year":"2011","unstructured":"Ryan, R. M. et al. Effect of enhanced ultraviolet germicidal irradiation in the heating ventilation and air conditioning system on ventilator-associated pneumonia in a neonatal intensive care unit. J. Perinatol. Off. J. Calif. Perinat. Assoc. 31, 607\u2013614 (2011).","journal-title":"J. Perinatol. Off. J. Calif. Perinat. Assoc."},{"key":"5562_CR11","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71 (2021).","journal-title":"BMJ"},{"key":"5562_CR12","doi-asserted-by":"publisher","first-page":"195","DOI":"10.5195\/jmla.2020.834","volume":"108","author":"JM Clark","year":"2020","unstructured":"Clark, J. M. et al. Improving the translation of search strategies using the polyglot search translator: a randomized controlled trial. J. Med. Libr. Assoc. 108, 195\u2013207 (2020).","journal-title":"J. Med. Libr. Assoc."},{"key":"5562_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4","volume":"5","author":"M Ouzzani","year":"2016","unstructured":"Ouzzani, M., Hammady, H., Fedorowicz, Z. & Elmagarmid, A. Rayyan-a web and mobile app for systematic reviews. Syst. Rev. 5, 210 (2016).","journal-title":"Syst. Rev."},{"key":"5562_CR14","doi-asserted-by":"publisher","first-page":"899193","DOI":"10.3389\/fped.2022.899193","volume":"10","author":"M Cai","year":"2022","unstructured":"Cai, M., Lin, L., Peng, Y., Chen, L. & Lin, Y. Effect of breast milk oral care on mechanically ventilated preterm infants: a systematic review and meta-analysis of randomized controlled trials. Front. Pediatr. 10, 899193 (2022).","journal-title":"Front. Pediatr."},{"key":"5562_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2023.104527","volume":"144","author":"ZY Fu","year":"2023","unstructured":"Fu, Z. Y. et al. The effect of oropharyngeal colostrum administration on the clinical outcomes of premature infants: a meta-analysis. Int. J. Nurs. Stud. 144, 104527 (2023).","journal-title":"Int. J. Nurs. Stud."},{"key":"5562_CR16","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1038\/s41390-020-0854-1","volume":"89","author":"A Ma","year":"2021","unstructured":"Ma, A., Yang, J., Li, Y., Zhang, X. & Kang, Y. Oropharyngeal colostrum therapy reduces the incidence of ventilator-associated pneumonia in very low birth weight infants: a systematic review and meta-analysis. Pediatr. Res. 89, 54\u201362 (2021).","journal-title":"Pediatr. Res."},{"key":"5562_CR17","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1093\/advances\/nmz033","volume":"10","author":"H Panchal","year":"2019","unstructured":"Panchal, H., Athalye-Jape, G. & Patole, S. Oropharyngeal colostrum for preterm infants: a systematic review and meta-analysis. Adv. Nutr. (Bethesda, Md) 10, 1152\u20131162 (2019).","journal-title":"Adv. Nutr. (Bethesda, Md)"},{"key":"5562_CR18","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1002\/jpn3.12085","volume":"78","author":"RP Anne","year":"2024","unstructured":"Anne, R. P., Kumar, J., Kumar, P. & Meena, J. Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: a systematic review and meta-analysis. J. Pediatr. Gastroenterol. Nutr. 78, 471\u2013487 (2024).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"5562_CR19","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1002\/ppul.25345","volume":"56","author":"T Abiramalatha","year":"2021","unstructured":"Abiramalatha, T., Ramaswamy, V. V., Thanigainathan, S., Pullattayil, A. K. & Kirubakaran, R. Frequency of ventilator circuit changes to prevent ventilator-associated pneumonia in neonates and children\u2014a systematic review and meta-analysis. Pediatr. Pulmonol. 56, 1357\u20131365 (2021).","journal-title":"Pediatr. Pulmonol."},{"key":"5562_CR20","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.2217\/fmb-2018-0108","volume":"13","author":"E Iosifidis","year":"2018","unstructured":"Iosifidis, E., Pitsava, G. & Roilides, E. Ventilator-associated pneumonia in neonates and children: a systematic analysis of diagnostic methods and prevention. Future Microbiol. 13, 1431\u20131446 (2018).","journal-title":"Future Microbiol."},{"key":"5562_CR21","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.jclinepi.2021.01.012","volume":"134","author":"JC Stone","year":"2021","unstructured":"Stone, J. C. et al. The methodological standards for epidemiological research (master) scale demonstrated a unified framework for bias assessment. J. Clin. Epidemiol. 134, 52\u201364 (2021).","journal-title":"J. Clin. Epidemiol."},{"key":"5562_CR22","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1097\/EDE.0b013e31815c24e7","volume":"19","author":"SA Doi","year":"2008","unstructured":"Doi, S. A. & Thalib, L. A quality-effects model for meta-analysis. Epidemiol. (Camb., Mass) 19, 94\u2013100 (2008).","journal-title":"Epidemiol. (Camb., Mass)"},{"key":"5562_CR23","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.cct.2015.05.010","volume":"45","author":"SA Doi","year":"2015","unstructured":"Doi, S. A., Barendregt, J. J., Khan, S., Thalib, L. & Williams, G. M. Advances in the meta-analysis of heterogeneous clinical trials II: the quality effects model. Contemp. Clin. trials 45, 123\u2013129 (2015).","journal-title":"Contemp. Clin. trials"},{"key":"5562_CR24","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.jval.2021.02.011","volume":"24","author":"JC Stone","year":"2021","unstructured":"Stone, J. C. et al. Bias assessment in outcomes research: the role of relative versus absolute approaches. Value Health J. Int. Soc. Pharmacoeconom. Outcomes Res. 24, 1145\u20131149 (2021).","journal-title":"Value Health J. Int. Soc. Pharmacoeconom. Outcomes Res."},{"key":"5562_CR25","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","volume":"327","author":"JPT Higgins","year":"2003","unstructured":"Higgins, J. P. T., Thompson, S. G., Deeks, J. J. & Altman, D. G. Measuring Inconsistency in meta-analyses. BMJ 327, 557\u2013560 (2003).","journal-title":"BMJ"},{"key":"5562_CR26","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1097\/XEB.0000000000000141","volume":"16","author":"L Furuya-Kanamori","year":"2018","unstructured":"Furuya-Kanamori, L., Barendregt, J. J. & Doi, S. A. R. A new improved graphical and quantitative method for detecting bias in meta-analysis. Int. J. Evid.-based Healthc. 16, 195\u2013203 (2018).","journal-title":"Int. J. Evid.-based Healthc."},{"key":"5562_CR27","doi-asserted-by":"crossref","unstructured":"Elmakaty, I. Mastering meta-analysis in Microsoft Excel with MetaXL add-in: a comprehensive tutorial and guide to meta-analysis. J. Eval. Clin. Pract. 31, e14138 (2025).","DOI":"10.1111\/jep.14138"},{"key":"5562_CR28","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1177\/002013240104600804","volume":"46","author":"L Cordero","year":"2001","unstructured":"Cordero, L., Sananes, M. & Ayers, L. W. A comparison of two airway suctioning frequencies in mechanically ventilated, very-low-birthweight infants. Respirat.Care 46, 783\u2013788 (2001).","journal-title":"Respirat.Care"},{"key":"5562_CR29","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1111\/jpc.15529","volume":"57","author":"R Aggarwal","year":"2021","unstructured":"Aggarwal, R., Plakkal, N. & Bhat, V. Does oropharyngeal administration of colostrum reduce morbidity and mortality in very preterm infants? A randomised parallel-group controlled trial. J. Paediatr. Child Health 57, 1467\u20131472 (2021).","journal-title":"J. Paediatr. Child Health"},{"key":"5562_CR30","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-06243-2","volume":"12","author":"LL Chen","year":"2022","unstructured":"Chen, L. L. et al. Oropharyngeal administration of mother\u2019s own milk influences levels of salivary siga in preterm infants fed by gastric tube. Sci. Rep. 12, 2233 (2022).","journal-title":"Sci. Rep."},{"key":"5562_CR31","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1038\/sj.jp.7200330","volume":"20","author":"L Cordero","year":"2000","unstructured":"Cordero, L., Sananes, M. & Ayers, L. W. Comparison of a closed (trach care mac) with an open endotracheal suction system in small premature infants. J. Perinatol. 20, 151\u2013156 (2000).","journal-title":"J. Perinatol."},{"key":"5562_CR32","first-page":"64","volume":"43","author":"D de la Rosa-Zamboni","year":"2025","unstructured":"de la Rosa-Zamboni, D. et al. Effect of Uv-C Disinfection and Copper Plating on Healthcare-Associated Infections in a Nicu with High Esbl Infections. Efecto de la desinfecci\u00f3n con UV-C y placas adhesivas de cobre en infecciones asociadas a la atenci\u00f3n a la salud en una UCIN con altas tasas de infecciones por. ESBL 43, 64\u201370 (2025).","journal-title":"ESBL"},{"key":"5562_CR33","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1017\/ice.2022.253","volume":"44","author":"MJ Edzards","year":"2023","unstructured":"Edzards, M. J., Jacobs, M. B., Song, X., Basu, S. K. & Hamdy, R. F. Polymyxin flushes for endotracheal tube suction catheters in extremely low birth-weight infants: any benefit in preventing ventilator-associated events? Infect. Control Hosp. Epidemiol. 44, 1345\u20131347 (2023).","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"5562_CR34","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.70000","volume":"30","author":"BIK Elsaeed","year":"2025","unstructured":"Elsaeed, B. I. K. et al. Effect of implementing training programme for nurses about care bundle on prevention of ventilator-associated pneumonia among newborns. Nurs. Crit. Care 30, e70000 (2025).","journal-title":"Nurs. Crit. Care"},{"key":"5562_CR35","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1007\/s00431-022-04726-y","volume":"182","author":"AK Gahan","year":"2023","unstructured":"Gahan, A. K., Jain, S., Khurana, S. & Chawla, D. Closed versus open endotracheal tube suction in mechanically ventilated neonates: a randomized controlled trial. Eur. J. Pediatr. 182, 785\u2013793 (2023).","journal-title":"Eur. J. Pediatr."},{"key":"5562_CR36","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1093\/tropej\/fmx044","volume":"64","author":"IK Gokce","year":"2018","unstructured":"Gokce, I. K. et al. Successful implementation of a bundle strategy to prevent ventilator-associated pneumonia in a neonatal intensive care unit. J. Trop. Pediatr. 64, 183\u2013188 (2018).","journal-title":"J. Trop. Pediatr."},{"key":"5562_CR37","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s13312-025-3373-7","volume":"62","author":"A Gupta","year":"2025","unstructured":"Gupta, A., Singh, M. V., Yadav, R. K., Monica & Shrivastava, A. Prevention of VAP using hypertonic saline nebulization in NICU: a randomized controlled trial. Indian Pediatrics 62, 109\u2013115 (2025).","journal-title":"Indian Pediatrics"},{"key":"5562_CR38","doi-asserted-by":"publisher","first-page":"143","DOI":"10.3329\/bmrcb.v47i2.57772","volume":"47","author":"I Jahan","year":"2021","unstructured":"Jahan, I. et al. Effectiveness of educational intervention in preventing ventilator associated pneumonia in neonatal intensive care unit: a cohort study. Bangladesh Med Res Counc. Bull. 47, 143\u2013150 (2021).","journal-title":"Bangladesh Med Res Counc. Bull."},{"key":"5562_CR39","doi-asserted-by":"publisher","first-page":"2570","DOI":"10.1002\/ppul.25451","volume":"56","author":"Y Katayama","year":"2021","unstructured":"Katayama, Y., Takanishi, H., Sato, Y., Fujita, S. & Enomoto, M. Effect of oral care in reducing the incidence of early-onset ventilator-associated pneumonia in preterm infants. Pediatr. Pulmonol. 56, 2570\u20132575 (2021).","journal-title":"Pediatr. Pulmonol."},{"key":"5562_CR40","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.jiac.2014.06.006","volume":"20","author":"F Kawanishi","year":"2014","unstructured":"Kawanishi, F. et al. Risk factors for ventilator-associated pneumonia in neonatal intensive care unit patients. J. Infect. Chemother. : Off. J. Jpn. Soc. Chemother. 20, 627\u2013630 (2014).","journal-title":"J. Infect. Chemother. : Off. J. Jpn. Soc. Chemother."},{"key":"5562_CR41","volume":"16","author":"D Khan","year":"2024","unstructured":"Khan, D., Waqar, F., Azim, N., Khan, O. & Sohail, A. Reduction of hospital-acquired infections through a nursing education program: a quality improvement project on the sensitization of nursing staff toward infection control in neonates. Cureus 16, e62656 (2024).","journal-title":"Cureus"},{"key":"5562_CR42","doi-asserted-by":"publisher","first-page":"e357","DOI":"10.1542\/peds.2014-2004","volume":"135","author":"J Lee","year":"2015","unstructured":"Lee, J. et al. Oropharyngeal colostrum administration in extremely premature infants: an Rct. Pediatrics 135, e357\u2013e366 (2015).","journal-title":"Pediatrics"},{"key":"5562_CR43","first-page":"2361","volume":"25","author":"DF Li","year":"2021","unstructured":"Li, D. F. et al. Prevention of neonatal ventilator-associated pneumonia through oral care with the combined use of colostrum and sodium bicarbonate. Eur. Rev. Med. Pharmacol. Sci. 25, 2361\u20132366 (2021).","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"5562_CR44","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1097\/00130478-200104000-00006","volume":"2","author":"IR Makhoul","year":"2001","unstructured":"Makhoul, I. R. et al. Frequency of change of ventilator circuit in premature infants: impact on ventilator-associated pneumonia. Pediatr. Crit. Care Med 2, 127\u2013132 (2001).","journal-title":"Pediatr. Crit. Care Med"},{"key":"5562_CR45","doi-asserted-by":"publisher","first-page":"761","DOI":"10.18203\/2349-3291.ijcp20231478","volume":"10","author":"MA Mannan","year":"2023","unstructured":"Mannan, M. A. et al. Administration colostrum in preventing mortality and morbidity in preterm infants. Int. J. Contemp. Pediatr. 10, 761\u2013768 (2023).","journal-title":"Int. J. Contemp. Pediatr."},{"key":"5562_CR46","first-page":"1467","volume":"41","author":"A Pinilla-Gonz\u00e1lez","year":"2021","unstructured":"Pinilla-Gonz\u00e1lez, A. et al. Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants. J. Perinatol. Off. J. Calif. Perinat. Assoc. 41, 1467\u20131473 (2021).","journal-title":"J. Perinatol. Off. J. Calif. Perinat. Assoc."},{"key":"5562_CR47","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1038\/s41372-022-01589-x","volume":"43","author":"NA Rodriguez","year":"2023","unstructured":"Rodriguez, N. A. et al. A randomized controlled trial of oropharyngeal therapy with mother\u2019s own milk for premature infants. J. Perinatol. 43, 601\u2013607 (2023).","journal-title":"J. Perinatol."},{"key":"5562_CR48","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1086\/666342","volume":"33","author":"VD Rosenthal","year":"2012","unstructured":"Rosenthal, V. D. et al. Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries. Infect. Control Hospital Epidemiol. 33, 704\u2013710 (2012).","journal-title":"Infect. Control Hospital Epidemiol."},{"key":"5562_CR49","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1055\/s-0039-1688817","volume":"37","author":"D Sharma","year":"2020","unstructured":"Sharma, D., Kaur, A., Farahbakhsh, N. & Agarwal, S. Role of oropharyngeal administration of colostrum in very low birth weight infants for reducing necrotizing enterocolitis: a randomized controlled trial. Am. J. Perinatol. 37, 716\u2013721 (2020).","journal-title":"Am. J. Perinatol."},{"key":"5562_CR50","first-page":"821","volume":"71","author":"D Shkurupii","year":"2018","unstructured":"Shkurupii, D. Prevention of ventilator-associated pneumonia in newborns. Wiadomosci. Lekarskie (Wars. Pol. 1960) 71, 821\u2013823 (2018).","journal-title":"Wiadomosci. Lekarskie (Wars. Pol. 1960)"},{"key":"5562_CR51","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.pedneo.2017.04.003","volume":"58","author":"R Snyder","year":"2017","unstructured":"Snyder, R. et al. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Pediatr. Neonatol. 58, 534\u2013540 (2017).","journal-title":"Pediatr. Neonatol."},{"key":"5562_CR52","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1038\/jp.2015.157","volume":"36","author":"K Sohn","year":"2016","unstructured":"Sohn, K., Kalanetra, K. M., Mills, D. A. & Underwood, M. A. Buccal administration of human colostrum: impact on the oral microbiota of premature infants. J. Perinatol. 36, 106\u2013111 (2016).","journal-title":"J. Perinatol."},{"key":"5562_CR53","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.cct.2013.03.010","volume":"35","author":"BM Stefanescu","year":"2013","unstructured":"Stefanescu, B. M., H\u00e9tu, C., Slaughter, J. C., O\u2019Shea, T. M. & Shetty, A. K. A pilot study of biotene oralbalance\u00ae gel for oral care in mechanically ventilated preterm neonates. Contemp. Clin. trials 35, 33\u201339 (2013).","journal-title":"Contemp. Clin. trials"},{"key":"5562_CR54","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s12098-021-03982-4","volume":"89","author":"KC Sudeep","year":"2022","unstructured":"Sudeep, K. C. et al. Oral application of colostrum and mother\u2019s own milk in preterm infants\u2014a randomized, controlled trial. Indian J. Pediatr. 89, 579\u2013586 (2022).","journal-title":"Indian J. Pediatr."},{"key":"5562_CR55","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1177\/09732179241264924","volume":"39","author":"S Suman","year":"2025","unstructured":"Suman, S. & Singh, S. Effect of compliance to ventilator bundle care in decreasing ventilator-associated pneumonia rates in a neonatal intensive care unit: a quality improvement initiative. J. Neonatal 39, 128\u2013136 (2025).","journal-title":"J. Neonatal"},{"key":"5562_CR56","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1177\/19345798241310739","volume":"18","author":"M Taha","year":"2025","unstructured":"Taha, M. et al. Does oral care with mother\u2019s colostrum reduce the risk of late-onset sepsis in preterm infants? A randomized clinical trial. J. Neonatal-Perinat. Med. 18, 79\u201385 (2025).","journal-title":"J. Neonatal-Perinat. Med."},{"key":"5562_CR57","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1016\/j.ajic.2013.06.007","volume":"41","author":"Q Zhou","year":"2013","unstructured":"Zhou, Q. et al. Efficacy of an infection control program in reducing ventilator-associated pneumonia in a Chinese neonatal intensive care unit. Am. J. Infect. Control 41, 1059\u20131064 (2013).","journal-title":"Am. J. Infect. Control"},{"key":"5562_CR58","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1016\/j.jointm.2023.04.004","volume":"3","author":"R Martinez-Reviejo","year":"2023","unstructured":"Martinez-Reviejo, R. et al. Prevention of ventilator-associated pneumonia through care bundles: a systematic review and meta-analysis. J. intensive Med. 3, 352\u2013364 (2023).","journal-title":"J. intensive Med."},{"key":"5562_CR59","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1590\/S0103-507X2008000400003","volume":"20","author":"IM Pagotto","year":"2008","unstructured":"Pagotto, I. M., Oliveira, L. R., Ara\u00fajo, F. C., Carvalho, N. A. & Chiavone, P. Comparison between open and closed suction systems: a systematic review. Rev. Brasileira de. Ter. Intensiv. 20, 331\u2013338 (2008).","journal-title":"Rev. Brasileira de. Ter. Intensiv."},{"key":"5562_CR60","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1093\/bja\/aem403","volume":"100","author":"II Siempos","year":"2008","unstructured":"Siempos, I. I., Vardakas, K. Z. & Falagas, M. E. Closed tracheal suction systems for prevention of ventilator-associated pneumonia. Br. J. Anaesth. 100, 299\u2013306 (2008).","journal-title":"Br. J. Anaesth."},{"key":"5562_CR61","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.jhin.2013.04.009","volume":"84","author":"M Jansson","year":"2013","unstructured":"Jansson, M., K\u00e4\u00e4ri\u00e4inen, M. & Kyng\u00e4s, H. Effectiveness of educational programmes in preventing ventilator-associated pneumonia: a systematic review. J. hospital Infect. 84, 206\u2013214 (2013).","journal-title":"J. hospital Infect."},{"key":"5562_CR62","first-page":"619","volume":"26","author":"FY Chai","year":"2024","unstructured":"Chai, F. Y. et al. Clinical study of prone positioning in invasive respiratory support for neonatal respiratory distress syndrome]. Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr. 26, 619\u2013624 (2024).","journal-title":"Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr."},{"key":"5562_CR63","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1007\/s00103-012-1545-9","volume":"55","author":"U Heudorf","year":"2012","unstructured":"Heudorf, U., Hausemann, A. & Jager, E. Hygiene in intensive care units in frankfurt am main, Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 55, 1483\u20131494 (2012).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"5562_CR64","first-page":"9","volume":"15","author":"XL Huang","year":"2013","unstructured":"Huang, X. L. et al. Clinical effectiveness of insure method in the treatment of neonatal respiratory distress syndrome]. Zhongguo Dang Dai er ke za zhi = Chin. J. Contemp. pediatrics 15, 9\u201313 (2013).","journal-title":"Zhongguo Dang Dai er ke za zhi = Chin. J. Contemp. pediatrics"},{"key":"5562_CR65","first-page":"406","volume":"14","author":"XC Li","year":"2012","unstructured":"Li, X. C., Wang, J. Z. & Liu, Y. H. Effect of probiotics on respiratory tract pathogen colonization in neonates undergoing mechanical ventilation]. Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr. 14, 406\u2013408 (2012).","journal-title":"Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr."},{"key":"5562_CR66","first-page":"32","volume":"60","author":"PI Mironov","year":"2015","unstructured":"Mironov, P. I. & Rudnov, V. A. Prevention of ventilator associated infection in neonates with respiratory distress syndrome]. Anesteziol. Reanimatol. 60, 32\u201335 (2015).","journal-title":"Anesteziol. Reanimatol."},{"key":"5562_CR67","first-page":"213","volume":"17","author":"H Wang","year":"2015","unstructured":"Wang, H., Du, L. Z., Tang, J., Wu, J. L. & Mu, D. Z. Clinical efficacy of preferred use of high-frequency oscillatory ventilation in treatment of neonatal pulmonary hemorrhage]. Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr. 17, 213\u2013216 (2015).","journal-title":"Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr."},{"key":"5562_CR68","first-page":"1227","volume":"18","author":"QZ Wei","year":"2016","unstructured":"Wei, Q. Z., Su, P., Han, J. T., Zhang, X. & Duan, Y. H. Effect of early caffeine treatment on the need for respirator therapy in preterm infants with respiratory distress syndrome]. Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr. 18, 1227\u20131231 (2016).","journal-title":"Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr."},{"key":"5562_CR69","first-page":"704","volume":"13","author":"XL Wu","year":"2011","unstructured":"Wu, X. L., Li, Y. F., Zhou, B. Y., Wu, L. J. & Wu, Z. J. Effects of bifidobacteria on respiratory and gastrointestinal tracts in neonates receiving mechanical ventilation. Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr. 13, 704\u2013707 (2011).","journal-title":"Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr."},{"key":"5562_CR70","first-page":"285","volume":"16","author":"WL Zhou","year":"2014","unstructured":"Zhou, W. L., Zhou, Q., Li, C. & Wu, H. Early use of calf pulmonary surfactant in late preterm and full-term infants with respiratory distress syndrome: a randomized controlled trial. Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr. 16, 285\u2013289 (2014).","journal-title":"Zhongguo dang dai er ke za zhi = Chin. J. Contemp. Pediatr."},{"key":"5562_CR71","doi-asserted-by":"crossref","unstructured":"Ceballos, K., Waterman, K., Hulett, T. & Makic, M. B. Nurse-driven quality improvement interventions to reduce hospital-acquired infection in the NICU. Adv. Neonatal Care 13, 154\u2013163 (2013).","DOI":"10.1097\/ANC.0b013e318285fe70"},{"key":"5562_CR72","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1097\/ANC.0000000000000635","volume":"19","author":"B Jacobs Pepin","year":"2019","unstructured":"Jacobs Pepin, B., Lesslie, D., Berg, W., Spaulding, A. B. & Pokora, T. Zap-vap: a quality improvement initiative to decrease ventilator-associated pneumonia in the neonatal intensive care unit, 2012-2016. Adv. Neonatal Care Off. J. Natl. Assoc. Neonatal Nurses 19, 253\u2013261 (2019).","journal-title":"Adv. Neonatal Care Off. J. Natl. Assoc. Neonatal Nurses"},{"key":"5562_CR73","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.3109\/14767050903387029","volume":"23","author":"E Rogers","year":"2010","unstructured":"Rogers, E., Alderdice, F., McCall, E., Jenkins, J. & Craig, S. Reducing nosocomial infections in neonatal intensive care. J. Matern. Fetal. Neonatal. Med. 23, 1039\u20131046 (2010).","journal-title":"J. Matern. Fetal. Neonatal. Med."},{"key":"5562_CR74","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1097\/ANC.0000000000000276","volume":"16","author":"CD Weber","year":"2016","unstructured":"Weber, C. D. Applying adult ventilator-associated pneumonia bundle evidence to the ventilated neonate. Adv. Neonatal Care Off. J. Natl. Assoc. Neonatal Nurses 16, 178\u2013190 (2016).","journal-title":"Adv. Neonatal Care Off. J. Natl. Assoc. Neonatal Nurses"}],"container-title":["Pediatric Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41390-026-05562-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-026-05562-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-026-05562-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:03:18Z","timestamp":1792699398000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41390-026-05562-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":74,"alternative-id":["5562"],"URL":"https:\/\/doi.org\/10.1038\/s41390-026-05562-8","relation":{},"ISSN":["0031-3998","1530-0447"],"issn-type":[{"value":"0031-3998","type":"print"},{"value":"1530-0447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]},"assertion":[{"value":"28 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Data in this study are extracted from published studies. Ethical approval and informed consent are not applicable.","order":2,"name":"Ethics","label":"Ethics approval and consent","group":{"name":"EthicsHeading","label":"Ethics"}}]}}