Prevention of Nosocomial Infections in Neonatal Intensive Care Units

Abstract

Sepsis-related morbidity and mortality is an increasing concern in all neonatal intensive care units (NICUs), and the reported incidences are dramatically high regardless of the improvements in the quality of neonatal assistance. 1 Neonatal sepsis includes bloodstream, urine, cerebrospinal, peritoneal, and lung infections, as well as infections starting from burns and wounds or from any other usually sterile site. It is associated with cytokine-and biomediatorinduced disorders of respiratory, hemodynamic, and metabolic processes that are triggered by infections.Many specific risk factors account for the increased risk of bacterial and fungal sepsis in such patients, including the use AbstractNeonatal sepsis causes a huge burden of morbidity and mortality and includes bloodstream, urine, cerebrospinal, peritoneal, and lung infections as well as infections starting from burns and wounds, or from any other usually sterile sites. It is associated with cytokine -and biomediator-induced disorders of respiratory, hemodynamic, and metabolic processes. Neonates in the neonatal intensive care unit feature many specific risk factors for bacterial and fungal sepsis. Loss of gut commensals such as Bifidobacteria and Lactobacilli spp., as occurs with prolonged antibiotic treatments, delayed enteral feeding, or nursing in incubators, translates into proliferation of pathogenic microflora and abnormal gut colonization. Prompt diagnosis and effective treatment do not protect septic neonates form the risk of late neurodevelopmental impairment in the survivors. Thus prevention of bacterial and fungal infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures, adoption of a cautious central venous catheter policy, enhancement of the enteric microbiota composition with the supplementation of probiotics, and medical stewardship concerning H2 blockers with restriction of their use. Additional measures may include the use of lactoferrin, fluconazole, and nystatin and specific measures to prevent ventilator associated pneumonia.

Bovine lactoferrin free of lipopolysaccharide can induce a proinflammatory response of macrophages

“…In humans, LF is known to be able to prevent the onset of sepsis in infants [46–48]. LF has a high homology among species [49] thus, heterologous molecules of LF are used as a therapeutic agents.…”

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

“…is associated with prolonged antibiotic treatments, delayed enteral feeding, or nursing in incubators and translates into proliferation of pathogenic microflora and abnormal gut colonization. Seemingly, enhancement of the enteric microbiota composition with supplementation of probiotics seems to be a good strategy to prevent sepsis and could also be applied to prevent neonatal VAP [72]. Nevertheless, a recent meta-analysis of 7 randomized controlled trials conducted in adult populations concluded that probiotics showed no beneficial effect in patients who are mechanically ventilated, did not significantly decrease the incidence of VAP, and should not be recommended for routine clinical application [73].…”

Microbiome Assembly across Multiple Body Sites in Low-Birthweight Infants

“…Furthermore, early life colonization deficiencies have been associated with alterations in host metabolism and immune function (18, 19). In the neonatal intensive care unit (NICU), however, the promotion of potentially beneficial host-microbe interactions must be carefully balanced against the control of pathogen spread among a highly vulnerable patient population (20, 21). This is distinctively challenging with regard to the prevention and treatment of NEC, a disease in which the interrelated roles of antibiotic exposure, enteral feedings, and changes in the intestinal microbiota are imprecisely defined (10, 11).…”