Background and Aims The improvement of central line insertion and maintenance practices has led to reduction but not elimination of central line-associated bloodstream infections (CLABSIs) in critically ill neonates. The objective of our study was to describe CLABSI epidemiology in critically ill neonates in order to identify risk factors for additional prevention strategies.

Methods Prospective cohort study in medical-surgical neonatal and pediatric ICU. All neonates admitted between January 1, 2011, and January 31, 2012 with ≥ 1 central lines were monitored for the development of CLABSI. Risk factors for CLABSI were examined.

Results Nine CLABSIs occurred during 1640 central line-days (5.5/1000 central line-days). Seven out of 9 CLABSIs (78%) occurred in neonates with primary surgical diagnosis (gastrointestinal tract anomaly 4, congenital heart disease 2, rabdomyosarcoma 1), two CLABSIs developed in neonates with hypoxic-ischemic encephalopathy. Neonates with CLABSI had significantly longer ICU length of stay compared to other neonates requiring central line (median 27 vs. 3 days; p<0.0001), higher PRISM III score (median 14.5 vs. 7; p=0.01), more surgical procedures (median 2 vs. 1; p=0.14), longer duration of parenteral nutrition (median 10 vs. 0 days; p<0.0001), received more red blood cell transfusions (median 5 vs. 0; p<0.0001), needed more vasopressor/inotropic agents (median 2 vs. 0; p=0.002).

Conclusion The incidence of CLABSI is significantly higher in neonates with primary surgical diagnosis (particularly gastrointestinal tract anomaly) and with hypoxic-ischemic encephalopathy compared to other neonates requiring a central line. The increased risk of CLABSI in these neonates warrants further study for development of additional prevention strategies.