Infection in the NICU and PICU

Abstract

The incidence of infection is higher in the neonatal period than at any time in life. Neonates, particularly preterm, are extremely susceptible to infection. Low birth weight is the single most important risk factor for infection in neonates. The reasons for this increased susceptibility include immune system immaturity, poor surface defences, lack of colonisation resistance, invasive medical devices and broad-spectrum antibiotic usage. Increased susceptibility to carriage and infection in preterm neonates is the main factor facilitating transmission of potential pathogens and subsequent outbreaks of infection in the neonatal intensive care unit (NICU). Stay in the NICU is substantially longer than in the paediatric ICU (PICU). Outbreaks are more common in the NICU than in the PICU, and higher overall mortality rates of 10% versus 5% support the observation that children in the NICU are more susceptible hosts than children in the PICU. In this chapter, we present data from four randomised controlled trials of selective digestive-tract decontamination in the paediatric population.