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Nosocomial bloodstream infections (NBSIs) occur frequently in neonatal intensive care units (NICUs) and are associated with substantial morbidity and mortality. Little has been published regarding variation in NBSI among institutions.To determine NBSI incidence among six NICUs and to explore how much variation is explained by patient characteristics and NICU practice patterns.From October, 1994, to June, 1996, six regional NICUs prospectively abstracted clinical records of all neonates weighing <1500 g. Occurrence of NBSI, defined as first positive culture occurring >48 h after admission, was analyzed in relation to baseline patient characteristics and several common therapeutic interventions. Variables significant in univariate analyses were analyzed by Cox proportional hazards regression.There were 258 NBSIs (incidence, 19.1%) among 1354 inborn first admissions. Incidence varied significantly by site, from 8.5 to 42%. Birth weight, Broviac catheter use and parenteral nutrition were significantly associated with NBSI (P < 0.05). When controlling for these variables interinstitutional variation in NBSI occurrence decreased but remained significant.Neonatal NBSI incidence varies substantially among institutions despite adjustment for length of stay and some known risk factors. The uses of Broviac catheters and especially intravenous nutrition supplements were significant determinants of NBSI risk.