{
  "abstract": "Introduction Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among neonates requiring life-saving mechanical ventilation in neonatal intensive care units (NICUs), particularly those who are born prematurely and/or with very-low-birth-weight (VLBW), or critically ill. Despite its clinical significance, neonatal VAP lacks standardised diagnostic criteria, resulting in variability in incidence reporting, over or under diagnosis and inappropriate antimicrobial use which further exacerbates the emergence of antibiotic-resistant organisms. Current diagnostic criteria and prevention strategies, often adapted from paediatric populations and adults, fail to address the unique anatomical and clinical characteristics of neonates. Building on a pilot investigation across Canadian NICUs, the goal of this study is to establish standardised, neonatal-specific VAP diagnostic criteria and prevention strategies to improve diagnostic accuracy, promote antimicrobial stewardship and enhance clinical outcomes.Methods and analysis Beginning in 2025, a 4-year, multicentre, prospectively-designed retrospective cohort study will be conducted across tertiary NICUs in Canada. All VLBW (birth weight <1500 g) neonates admitted to participating NICUs will be included. Our first aim is to use the Canadian Neonatal Network (CNN) platform, integrated with advanced data screening tools, to collect standardised demographic, clinical, ventilatory and microbiological data to assess VAP incidence and outcomes based on existing definitions. Next, we will develop a neonatal-specific VAP diagnostic criteria, by combining statistical analyses, including univariate analysis, multivariable logistic regression and receiver operating characteristic analyses, with expert consensus building through the Delphi method. Concurrently, we will focus on implementing evidence-based VAP prevention strategies and evaluate outcome measures, such as VAP incidence, adherence to prevention bundles and antimicrobial stewardship practices.Ethics and dissemination This study has received ethics approval from the University of Alberta Health Research Ethics Board-Health Panel (Pro00149177). Findings will be disseminated through open-access publications, conference presentations and online platforms to promote widespread adoption.Trial registration number NCT07109791.",
  "authors": [
    {
      "affiliations": [
        "Department of Paediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"
      ],
      "name": "Christie Z Li"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada",
        "Women and Children’s Health Research Institute, Edmonton, Alberta, Canada"
      ],
      "name": "Alena Tse-Chang"
    },
    {
      "affiliations": [
        "Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Eugene W Yoon"
    },
    {
      "affiliations": [
        "School of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Vanessa Paquette"
    },
    {
      "affiliations": [
        "Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Ashley Roberts"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Dalhousie University, Halifax, Nova Scotia, Canada"
      ],
      "name": "Jehier Afifi"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Connie L Yang"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Neonatal Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Faiza Khurshid"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Unit, Windsor Regional Hospital, Windsor, Ontario, Canada"
      ],
      "name": "Sajit Augustine"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Julie Choudhury"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada",
        "Neonatal Intensive Care Unit, Foothills Medical Centre, Calgary, Alberta, Canada"
      ],
      "name": "Adel Elsharkawy"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Unit, Foothills Medical Centre, Calgary, Alberta, Canada"
      ],
      "name": "Claire Hamilton"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada",
        "Women and Children’s Health Research Institute, Edmonton, Alberta, Canada"
      ],
      "name": "Matthew Hicks"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada",
        "Women and Children’s Health Research Institute, Edmonton, Alberta, Canada"
      ],
      "name": "Chloe Joynt"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"
      ],
      "name": "Dianna Wang"
    },
    {
      "affiliations": [
        "Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Kyong-Soon Lee"
    },
    {
      "affiliations": [
        "Section of Neonatology, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Deepak Louis"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"
      ],
      "name": "Joan L Robinson"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Neonatal Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Adel Mohamed"
    },
    {
      "affiliations": [
        "Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Souvik Mitra"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Neonatal Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Vibhuti S Shah"
    },
    {
      "affiliations": [
        "Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Jocelyn A Srigley"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Unit, Royal Columbian Hospital, New Westminster, British Columbia, Canada"
      ],
      "name": "Miroslav Stavel"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Unit, Surrey Memorial Hospital, Surrey, British Columbia, Canada"
      ],
      "name": "Rebecca Sherlock"
    },
    {
      "affiliations": [
        "Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Jonathan Wong"
    },
    {
      "affiliations": [
        "Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Mimi TY Kuan"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Akpoembele Deborah Madise-Wobo"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Brigitte Lemyre"
    },
    {
      "affiliations": [
        "Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"
      ],
      "name": "Cynthia Joly"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Neonatal Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Ashraf Kharrat"
    },
    {
      "affiliations": [
        "Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Shikha Gupta-Bhatnagar"
    },
    {
      "affiliations": [
        "Neonatal Intensive Care Unit, British Columbia Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada"
      ],
      "name": "Mark Zarembo"
    },
    {
      "affiliations": [
        "Canadian Premature Babies Foundation/Fondation pour Bébés Prématurés Canadiens, Toronto (Etobicoke), Ontario, Canada"
      ],
      "name": "Fabiana Bacchini"
    },
    {
      "affiliations": [
        "Department of Paediatrics, McGill University, Montreal, Quebec, Canada"
      ],
      "name": "Marc Beltempo"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada",
        "Neonatal Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Prakesh S Shah"
    },
    {
      "affiliations": [
        "Department of Paediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada",
        "Women and Children’s Health Research Institute, Edmonton, Alberta, Canada",
        "Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Joseph Y Ting"
    }
  ],
  "title": "Protocol for developing a national approach to surveillance and prevention for neonatal ventilator-associated pneumonia",
  "uid": "d875d21c-d6c1-5a4e-be89-c6cd7dabd096"
}