Strategies to Limit Infections in the Neonate and to Reduce Infection-related Mortality

Abstract

Health-care associated infections remain a major problem in the neonatal intensive care unit (NICU), resulting in significant morbidity and mortality. Specifically, bloodstream infections have been associated with adverse neurodevelopmental outcomes among preterm infants with birth weight <1000 grams. In addition, these infections are associated with prolonged duration of hospitalization among survivors and increased cost of neonatal health care. It is clear that preventive strategies are urgently needed. Many bloodstream infections in the NICU are associated with the use of central venous catheters, and implementation of evidence-based measures as well as bundles has reduced their occurrence. Nevertheless, much work remains. Candidal infections have become more prevalent in the NICU, and fluconazole prophylaxis is being recommended and used to prevent candidiasis among infants with birth weight <1000 grams. Although fluconazole prophylaxis has reduced invasive candidal infections, the underlying risk factors that result in Candida becoming a more common pathogen remain, namely the overuse of antibiotics especially the third generation cephalosporins. In addition, the use of H2 blocker also has contributed to Candidal colonization and late onset sepsis. Recent results of randomized clinical trials have shown beneficial effects of probiotics for prevention of necrotizing enterocolitis and lactoferrin for prevention of late onset sepsis. Finally, the need to vaccinate not only our preemies but also staff and family members of babies in the NICU will further reduce the likelihood of introducing community-associated pathogens into the NICU. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive