Official Statistics

Supplementary results for pediatric and neonatal units, England: May 2016 to March 2024

Published 17 October 2024

Applies to England

This supplementary report contains additional results for paediatric and neonatal units. Given the low participation rates of such units in this surveillance programme, it is important to interpret the following results with caution.

Paediatric units

Trends in paediatric critical care units (CCU) differed considerably from those described across all CCUs in the ‘Overview’ section of the main report.

This is likely due in part to the small event counts in paediatric CCUs, leading to more variability in rates. Also, participation of paediatric CCUs was lower, with only 4 units participating in financial year (FY) 2023 to 2024 (17.4% of all paediatric CCUs identified in external audits, see supplementary Table S1.

Incidence rates

PBCs, BSIs and CCU-BSIs

In FY 2023 to 2024, there were 12 positive blood cultures (PBC) reported (1.8 per 1,000 bed-days) in paediatric units, of which 4 (33.3%) were considered bloodstream infections (BSI) (0.6 per 1,000 bed-days). Two (50.0% of BSIs) were considered CCU-associated BSI (CCU-BSI, 0.4 per 1,000 bed-days over 2 nights).

The rate of PBCs was 2.7 per 1,000 bed-days in FY 2017 to 2018 , rising to a peak of 4.8 in FY 2019 to 2020, and dropping to 1.8 in FY 2023 to 2024. Similarly, the rate of BSIs was 1.1 per 1,000 bed-days in FY 2017 to 2018, rising to a peak of 2.3 in FY 2019 to 2020, and reducing to 0.6 in FY 2023 to 2024 (Figure S1, supplementary Table S2).

CCU-BSI rates rose from 1.7 per 1,000 bed-days over 2 nights in FY 2017 to 2018 to a peak of 2.7 in FY 2019 to 2020, before falling to 0.4 in FY 2023 to 2024. There was a sudden drop in rate between FY 2019 to 2020 and FY 2020 to 2021, which was accompanied by a halving of reported bed-days over 2 nights. This went from 11,486 in FY 2019 to 2020 to 5,716 in FY 2020 to 2021. The number of reported bed-days has not since rebounded (Figure S2, supplementary Table S1).

The peaks seen across these outcomes do not match those seen in adult CCUs in the ‘Adult units’ section of the main report, with peaks occurring prior to the COVID-19 pandemic in paediatric CCUs. However, caution should be taken with interpreting this data, due to small numbers.

Figure S1. Rates of positive blood cultures (PBC) and bloodstream infections (BSI) per 1,000 bed-days, in paediatric units, England: between FY 2016 to 2017 and FY 2023 to 2024

Figure S2. Rates of CCU-associated bloodstream infections (CCU-BSI) per 1,000 bed-days over 2 nights), in paediatric units, England: between FY 2016 to 2017 and FY 2023 to 2024

CVC-associated infections

In FY 2023 to 2024, there were no cases classified as CCU central vascular catheter BSI (CCU-CVC-BSI) in paediatric units. As with the outcomes described above, trends in paediatric CCU-CVC-BSIs differed markedly from those observed in adult CCUs (supplementary Table S3) and caution must be applied when interpreting trends due to very small numbers.

The rate of CCU-CVC-BSIs rose from 0.6 per 1,000 CVC bed-days over 2 nights in FY 2017 to 2018 to a peak of 2.4 in FY 2019 to 2020, then returning to 0.6 in FY 2022 to 2023 (Figure S3, supplementary Table S3). Of note, the reported paediatric CVC bed-days over 2 nights approximately halved between the FY 2019 to 2020 and FY 2020 to 2021 and have since stayed at this level.

Figure S3. Rates of CCU-associated central-vascular-catheter bloodstream infections (CCU-CVC-BSI) per 1,000 CVC-days over 2 nights, in paediatric units, England: between FY 2016 to 2017 and FY 2023 to 2024

Organism distribution

Of the 16 isolates from positive blood cultures reported in paediatric CCUs in FY 2023 to 2024, 10 (62.5%) isolated were coagulase-negative Staphylococci (CoNS), only 2 of which met BSI definition. Five other BSI isolates were identified in FY 2023 to 2024, one each (14.3%) of Streptococcus (non-viridans), Enterococcus spp., P. aeruginosa, Acinetobacter spp. and ‘Other bacteria’. The cases were defined as CCU-BSIs in one of the two cases of CoNS, as well as in the cases associated with Enterococcus spp., Acinetobacter spp. and ‘Other bacteria’ (Figure S4, supplementary Tables S6 to S9).

Figure S4 shows organisms aggregated in 10 key groups. A more detailed breakdown of the ‘Other Gram-negative’, ‘Candida spp.’, and ‘Other’ groups is presented in supplementary Tables S6 to S9.

Figure S4. Rate of BSIs per 10,000 bed-days, by organism group, paediatric CCUs, England, between FY 2016 to 2017 and FY 2023 to 2024

CVC utilisation

In paediatric units, among patients with at least one PBC, CVC utilisation was relatively stable between FY 2016 to 2017 and FY 2018 to 2019, varying between 56.1% and 56.6%. There was a small drop to a low of 52.0% in FY 2020 to 2021 before rising back to 55.8% by FY 2023 to 2024 (Figure S5, supplementary Table S3).

Figure S5. Central vascular catheter (CVC) utilisation in paediatric units, England: between FY 2016 to 2017 and FY 2023 to 2024

Neonatal units

Trends in neonatal critical care units differed considerably from those described across all CCUs in the ‘Overview’ section of the main report.

This is likely due in part to the small event counts in neonatal CCUs, leading to more variability in rates. Also, participation of neonatal CCUs was much lower, with only 6 units participating in FY 2023 to 2024 (3.9% of all neonatal CCUs as identified with external audits, Table 1 in main report).

Incidence rates

PBCs, BSIs and CCU-BSIs

Trends in the rates of PBCs, BSIs and CCU-BSIs in neonatal CCUs differed considerably from those described across all CCU unit types in the ‘Overview’ section of this report. This may in part be due to low representation of neonatal CCUs. In general, the trendlines in neonatal CCUs observed more fluctuations. BSIs were the exception, with no peaks seen coinciding with the COVID-19 pandemic, unlike those observed in adult and paediatric CCUs.

In FY 2023 to 2024, there were 90 PBCs reported (2.6 per 1,000 bed-days) in neonatal units, of which 28 (31.1%) were considered BSIs (0.8 per 1,000 bed-days), and 21 (75.0% of BSIs) were considered CCU-BSIs (0.7 per 1,000 bed-days over 2 nights).

Over the course of the surveillance period, rates across the metrics remained mostly stable, with the rate of PBCs fluctuating between 2.6 and 3.8 per 1,000 bed-days. The rate of BSIs fluctuated between 0.6 and 1.0 per 1,000 bed-days, and the rate of CCU-BSIs fluctuated between 0.5 and 0.9 per 1,000 bed-days over 2 nights. No notable trends were seen for any of these outcomes (Figure S6 and S7, supplementary Table S2).

Figure S6. Rates of positive blood cultures (PBC) and bloodstream infections (BSI) per 1,000 bed-days, in neonatal units, England: between FY 2016 to 2017 and FY 2023

Figure S7. Rates of CCU-associated bloodstream infections (CCU-BSI) per 1,000 bed-days over 2 nights), in neonatal units, England: between FY 2016 to 2017 and FY 2023 to 2024

CVC-associated infections

In FY 2023 to 2024, there were 7 cases (33.3% of CCU-BSIs) classified as CCU-CVC-BSIs (1.1 per 1,000 CVC bed-days over 2 nights) in neonatal units. Of these, 7 (100.0%) were defined as CABSIs (1.1 per 1,000 CVC bed-days over 2 nights) and 3 (42.9%) were defined as CRBSIs (0.7 per 1,000 CVC bed-days over 2 nights). As with the outcomes described above, trends in CCU-CVC-BSIs in neonatal CCUs differed from those observed across all CCUs. However, trendlines for CCU-CVC-BSIs observed more fluctuations, unlike those described for PBCs, BSIs and CCU-BSIs, in part due to smaller counts (supplementary Table S3).

There was a large reduction in rates of CCU-CVC-BSIs coinciding with the beginning of the COVID-19 pandemic in 2020 (Figure S8, supplementary Table S3). This finding is similar to that seen in paediatric units. However, it is the opposite of that observed in adult CCUs, where the rate of all outcomes increased in FY 2020 to 2021. However, these differences may be in part due to small numbers.

The observed rate of CCU-CVC-BSIs rose from 1.4 per 1,000 CVC bed-days over 2 nights in FY 2016 to 2017 to a peak of 2.2 in FY 2019 to 2020, before reducing to between 0.6 and 0.8 in the in FY 2020 to 2022. This rate rebounded in FY 2022 to 2023, increasing to 1.7 per 1,000 CVC bed-days over 2 nights.

It should be noted that event counts were small for catheter-related outcomes. As such, identified trends are unlikely to be statistically meaningful.

Figure S8. Rates of CCU-associated central-vascular-catheter bloodstream infections (CCU-CVC-BSI) per 1,000 CVC-days over 2 nights, in neonatal units, England: between FY 2016 to 2017 and FY 2023 to 2024

Organism distribution

Of the 103 isolates from PBCs reported by neonatal units in FY 2023 to 2024, the majority were CoNS (55 cases, 53.4%).

Only 9 of these met the BSI case definition, but CoNS were still the most common BSI isolates, constituting 31.0% of the 29 BSI isolates. The other main pathogens for BSIs included 6 E. coli cases (20.7%), 5 Enterobacter spp. (17.2%), and 2 each (6.9%) of Streptococcus non-viridans, Serratia spp., and Other Enterobacteriaceae. The distribution was similar for CCU-BSI cases (supplementary Tables S6 to S9).

Of note, there were no Candida spp. isolates reported in BSIs from neonatal units.

Figure S9 shows organisms aggregated in nine key groups. A more detailed breakdown of the ‘Other Gram-negative’ and ‘Other’ groups is presented in supplementary Tables S5 to S8.

Figure S9. Rate of BSIs per 10,000 bed-days, by organism group, neonatal CCUs, England, between FY 2016 to 2017 and FY 2023 to 2024

CVC utilisation

CVC utilisation was much lower in neonatal units across the surveillance period compared with adult and paediatric units. In neonatal units, among patients with at least one PBC, CVC utilisation was relatively stable, varying between 20.5% and 26.9% (Figure S10, supplementary Table S3).

Figure S10. Central vascular catheter (CVC) utilisation in neonatal units, England: between FY 2016 to 2017 and FY 2023 to 2024