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).

Article 
PubMed 
PubMed Central 

Google Scholar
 

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, 427–434 (2014).

Article 
PubMed 

Google Scholar
 

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).

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).

Article 
PubMed 
PubMed Central 

Google Scholar
 

Thatrimontrichai, A. et al. Outcomes and risk factors of ventilator-associated pneumonia in neonates. World J. Pediatr. 13, 328–334 (2017).

Article 
PubMed 

Google Scholar
 

Azab, S. F. et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using “Vap Prevention Bundle”: a cohort study. BMC Infect. Dis. 15, 314 (2015).

Article 
PubMed 
PubMed Central 

Google Scholar
 

Abd-Elgawad, M., Eldegla, H., Khashaba, M. & Nasef, N. Oropharyngeal administration of mother’s milk prior to gavage feeding in preterm infants: a pilot randomized control trial. JPEN J. Parenter. Enter. Nutr. 44, 92–104 (2020).

Article 

Google Scholar
 

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, 287–293 (2015).

Ezzeldin, Z. et al. Nebulized hypertonic saline to prevent ventilator associated pneumonia in premature infants, a randomized trial. J. Matern. Fetal. Neonatal. Med. 31, 2947–2952 (2018).

Article 
PubMed 

Google Scholar
 

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, 607–614 (2011).


Google Scholar
 

Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71 (2021).

Article 
PubMed 
PubMed Central 

Google Scholar
 

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, 195–207 (2020).

Article 
PubMed 
PubMed Central 

Google Scholar
 

Ouzzani, M., Hammady, H., Fedorowicz, Z. & Elmagarmid, A. Rayyan-a web and mobile app for systematic reviews. Syst. Rev. 5, 210 (2016).

Article 
PubMed 
PubMed Central 

Google Scholar
 

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).

Article 
PubMed 
PubMed Central 

Google Scholar
 

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).

Article 
PubMed 

Google Scholar
 

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, 54–62 (2021).

Article 
PubMed 

Google Scholar
 

Panchal, H., Athalye-Jape, G. & Patole, S. Oropharyngeal colostrum for preterm infants: a systematic review and meta-analysis. Adv. Nutr. (Bethesda, Md) 10, 1152–1162 (2019).

Article 

Google Scholar
 

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, 471–487 (2024).

Article 
PubMed 

Google Scholar
 

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—a systematic review and meta-analysis. Pediatr. Pulmonol. 56, 1357–1365 (2021).

Article 
PubMed 

Google Scholar
 

Iosifidis, E., Pitsava, G. & Roilides, E. Ventilator-associated pneumonia in neonates and children: a systematic analysis of diagnostic methods and prevention. Future Microbiol. 13, 1431–1446 (2018).

Article 
PubMed 

Google Scholar
 

Stone, J. C. et al. The methodological standards for epidemiological research (master) scale demonstrated a unified framework for bias assessment. J. Clin. Epidemiol. 134, 52–64 (2021).

Article 
PubMed 

Google Scholar
 

Doi, S. A. & Thalib, L. A quality-effects model for meta-analysis. Epidemiol. (Camb., Mass) 19, 94–100 (2008).

Article 

Google Scholar
 

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, 123–129 (2015).

Article 
PubMed 

Google Scholar
 

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, 1145–1149 (2021).

Article 

Google Scholar
 

Higgins, J. P. T., Thompson, S. G., Deeks, J. J. & Altman, D. G. Measuring Inconsistency in meta-analyses. BMJ 327, 557–560 (2003).

Article 
PubMed 
PubMed Central 

Google Scholar
 

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, 195–203 (2018).

Article 
PubMed 

Google Scholar
 

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).

Cordero, L., Sananes, M. & Ayers, L. W. A comparison of two airway suctioning frequencies in mechanically ventilated, very-low-birthweight infants. Respirat.Care 46, 783–788 (2001).

Article 

Google Scholar
 

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, 1467–1472 (2021).

Article 
PubMed 

Google Scholar
 

Chen, L. L. et al. Oropharyngeal administration of mother’s own milk influences levels of salivary siga in preterm infants fed by gastric tube. Sci. Rep. 12, 2233 (2022).

Article 
PubMed 
PubMed Central 

Google Scholar
 

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, 151–156 (2000).

Article 
PubMed 

Google Scholar
 

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 desinfección con UV-C y placas adhesivas de cobre en infecciones asociadas a la atención a la salud en una UCIN con altas tasas de infecciones por. ESBL 43, 64–70 (2025).


Google Scholar
 

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, 1345–1347 (2023).

Article 
PubMed 

Google Scholar
 

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).

Article 
PubMed 

Google Scholar
 

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, 785–793 (2023).

Article 
PubMed 

Google Scholar
 

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, 183–188 (2018).

Article 
PubMed 

Google Scholar
 

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, 109–115 (2025).

Article 
PubMed 

Google Scholar
 

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, 143–150 (2021).

Article 

Google Scholar
 

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, 2570–2575 (2021).

Article 
PubMed 

Google Scholar
 

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, 627–630 (2014).

Article 

Google Scholar
 

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).

PubMed 
PubMed Central 

Google Scholar
 

Lee, J. et al. Oropharyngeal colostrum administration in extremely premature infants: an Rct. Pediatrics 135, e357–e366 (2015).

Article 
PubMed 

Google Scholar
 

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, 2361–2366 (2021).

PubMed 

Google Scholar
 

Makhoul, I. R. et al. Frequency of change of ventilator circuit in premature infants: impact on ventilator-associated pneumonia. Pediatr. Crit. Care Med 2, 127–132 (2001).

Article 
PubMed 

Google Scholar
 

Mannan, M. A. et al. Administration colostrum in preventing mortality and morbidity in preterm infants. Int. J. Contemp. Pediatr. 10, 761–768 (2023).

Article 

Google Scholar
 

Pinilla-González, A. et al. Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants. J. Perinatol. Off. J. Calif. Perinat. Assoc. 41, 1467–1473 (2021).


Google Scholar
 

Rodriguez, N. A. et al. A randomized controlled trial of oropharyngeal therapy with mother’s own milk for premature infants. J. Perinatol. 43, 601–607 (2023).

Article 
PubMed 

Google Scholar
 

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, 704–710 (2012).

Article 

Google Scholar
 

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, 716–721 (2020).

Article 
PubMed 

Google Scholar
 

Shkurupii, D. Prevention of ventilator-associated pneumonia in newborns. Wiadomosci. Lekarskie (Wars. Pol. 1960) 71, 821–823 (2018).


Google Scholar
 

Snyder, R. et al. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Pediatr. Neonatol. 58, 534–540 (2017).

Article 
PubMed 

Google Scholar
 

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, 106–111 (2016).

Article 
PubMed 

Google Scholar
 

Stefanescu, B. M., Hétu, C., Slaughter, J. C., O’Shea, T. M. & Shetty, A. K. A pilot study of biotene oralbalance® gel for oral care in mechanically ventilated preterm neonates. Contemp. Clin. trials 35, 33–39 (2013).

Article 
PubMed 

Google Scholar
 

Sudeep, K. C. et al. Oral application of colostrum and mother’s own milk in preterm infants—a randomized, controlled trial. Indian J. Pediatr. 89, 579–586 (2022).

Article 
PubMed 

Google Scholar
 

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, 128–136 (2025).

Article 

Google Scholar
 

Taha, M. et al. Does oral care with mother’s colostrum reduce the risk of late-onset sepsis in preterm infants? A randomized clinical trial. J. Neonatal-Perinat. Med. 18, 79–85 (2025).

Article 

Google Scholar
 

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, 1059–1064 (2013).

Article 
PubMed 

Google Scholar
 

Martinez-Reviejo, R. et al. Prevention of ventilator-associated pneumonia through care bundles: a systematic review and meta-analysis. J. intensive Med. 3, 352–364 (2023).

Article 
PubMed 
PubMed Central 

Google Scholar
 

Pagotto, I. M., Oliveira, L. R., Araújo, F. C., Carvalho, N. A. & Chiavone, P. Comparison between open and closed suction systems: a systematic review. Rev. Brasileira de. Ter. Intensiv. 20, 331–338 (2008).

Article 

Google Scholar
 

Siempos, I. I., Vardakas, K. Z. & Falagas, M. E. Closed tracheal suction systems for prevention of ventilator-associated pneumonia. Br. J. Anaesth. 100, 299–306 (2008).

Article 
PubMed 

Google Scholar
 

Jansson, M., Kääriäinen, M. & Kyngäs, H. Effectiveness of educational programmes in preventing ventilator-associated pneumonia: a systematic review. J. hospital Infect. 84, 206–214 (2013).

Article 

Google Scholar
 

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, 619–624 (2024).


Google Scholar
 

Heudorf, U., Hausemann, A. & Jager, E. Hygiene in intensive care units in frankfurt am main, Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 55, 1483–1494 (2012).

Article 
PubMed 

Google Scholar
 

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, 9–13 (2013).


Google Scholar
 

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, 406–408 (2012).


Google Scholar
 

Mironov, P. I. & Rudnov, V. A. Prevention of ventilator associated infection in neonates with respiratory distress syndrome]. Anesteziol. Reanimatol. 60, 32–35 (2015).

PubMed 

Google Scholar
 

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, 213–216 (2015).


Google Scholar
 

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, 1227–1231 (2016).


Google Scholar
 

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, 704–707 (2011).


Google Scholar
 

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, 285–289 (2014).


Google Scholar
 

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, 154–163 (2013).

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, 253–261 (2019).

Article 

Google Scholar
 

Rogers, E., Alderdice, F., McCall, E., Jenkins, J. & Craig, S. Reducing nosocomial infections in neonatal intensive care. J. Matern. Fetal. Neonatal. Med. 23, 1039–1046 (2010).

Article 
PubMed 

Google Scholar
 

Weber, C. D. Applying adult ventilator-associated pneumonia bundle evidence to the ventilated neonate. Adv. Neonatal Care Off. J. Natl. Assoc. Neonatal Nurses 16, 178–190 (2016).

Article 

Google Scholar