From: Ventilator-associated pneumonia in neonates, infants and children
Neonates | Onset >72Â h after birth and one of the following radiologic criteria: |
-new or progressive infiltrates | |
-consolidations | |
-adhesions or fluid in lobar fissures/pleura | |
And | |
Worsening gas exchange (SaO2 ↓; O2 requirement ↑; Ventilation parameters ↑) | |
And | |
Four of the following signs and symptoms: | |
-fever (>38.0°C), hypothermia (<36.5°C), or temperature instability | |
-new onset or increasing bradycardia (<80/min) or tachycardia (>200/min) | |
-new onset or increasing tachypnoea (>60/min) or apnoea (>20Â seconds) | |
-new onset or increasing signs of dyspnoea (retractions, nasal flaring, grunting) | |
-increasing production of respiratory secretions and need for suctioning | |
-purulent tracheal secretion | |
-isolation of a pathogen in respiratory secretions | |
 | -elevated C-reactive protein (>20 mg/L) |
I/T-ratio >0.2 | |
Infants: 2–11 months | One of the following radiologic criteria: |
-new or progressive infiltrate | |
-consolidations | |
-cavitations | |
-pneumatoceles | |
And | |
Worsening gas exchange (SaO2 ↓; O2 requirement ↑; Ventilation parameters ↑) | |
And | |
Three of the following signs and symptoms: | |
-fever (>38.0°C), hypothermia (<36.5°C), or temperature instability | |
-leucopenia (<4000 WBC/mm3) or leucocytosis (≥15,000 WBC/mm3) with left shift (≥10% band forms) | |
-new onset of purulent sputum, or change in character of sputum, or increased respiratory secretions, or increased suctioning requirements | |
-apnoea or dyspnoea (tachypnoea, nasal flaring, retraction of chest wall, grunting) | |
-wheezing, rales, or rhonchi | |
-cough | |
-bradycardia (<100/min) or tachycardia (>170/min) | |
Children: 1–16 years | One of the following radiologic criteria: |
-new or progressive and persistent infiltrate | |
-consolidation | |
-cavitation | |
And | |
Three of the following signs and symptoms: | |
-fever (>38.4°C) or hypothermia (<36.5°C) | |
-leukopenia (<4000 WBC/mm3) or leucocytosis (≥15,000 WBC/mm3) | |
-new onset of purulent sputum or change in character of sputum or increased respiratory secretions or increased suctioning requirements | |
-new onset or worsening cough or dyspnoea, apnoea, or tachyponea | |
-rales or bronchial breath sounds | |
 | -worsening gas exchange (SaO2 ↓; O2 requirement ↑; Ventilation parameters ↑) |