J Korean Soc Matern Child Health.  2022 Jan;26(1):1-9. 10.21896/jksmch.2022.26.1.1.

Evaluation and Management of Main Bacterial Infections in Premature Infants

• Cho KH

• KMID: 2525366
• DOI: http://doi.org/10.21896/jksmch.2022.26.1.1

Abstract

Infection and sepsis in preterm infants are a leading cause of morbidity and mortality. Compared with full-term infants, preterm infants are more susceptible to infection owing to their distinct immune function, prolonged hospitalization, and higher likelihood of undergoing invasive procedures. Timely recognition and intervention are the key factors for good prognosis. This requires rapid and accurate diagnosis and empirical antibiotics against the pathogen based on each neonatal intensive care unit's epidemiology. Judicious anti biotics use is important following accurate identification of the causative pathogen. Simultaneous supportive management such as breast feeding should be encouraged to improve an infant’s defense mechanism. In essence, prevention is paramount because sepsis is known to contribute to significant neuro­developmental sequelae. Thorough understanding of immune function, good diagnostic protocol, appropriate antibiotics management, and strict preventive strategies may improve short- and long-term outcomes in premature infants.

Keyword

Neonate, Preterm infant, Sepsis

Reference

AlFaleh K., Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Evid Based Child Health. 2014. 9:584–671.

Alshaikh B., Yusuf K., Sauve R. Neurodevelopmental outcomes of very low birth weight infants with neonatal sepsis: sys-tematic review and meta-analysis. J Perinatol. 2013. 33:558–64.

Bae YM., Bae CW., Oh MH., Lee SH., Woo KM., Jung KB. Effect of exogenous surfactant therapy on levels of pulmonary surfactant proteins A and D in preterm infants with respi-ratory distress syndrome. J Perinat Med. 2009. 37:561–4.

Benjamin DK., DeLong E., Cotten CM., Garges HP., Steinbach WJ., Clark RH. Mortality following blood culture in premature infants: increased with Gram-negative bacteremia and candidemia, but not Gram-positive bacteremia. J Pe-rinatol. 2004. 24:175–80.

Cantón-Bulnes ML., Garnacho-Montero J. Practical approach to the management of catheter-related bloodstream infection. Rev Esp Quimioter. 2019. 32(Suppl 2):38–41.

Capretti MG., Sandri F., Tridapalli E., Galletti S., Petracci E., Faldella G. Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants. Am J Infect Control. 2008. 36:430–5.

Chan KY., Lam HS., Cheung HM., Chan AK., Li K., Fok TF, et al. Rapid identification and differentiation of Gram-negative and Gram-positive bacterial bloodstream infections by quantitative polymerase chain reaction in preterm infants. Crit Care Med. 2009. 37:2441–7.

Chawanpaiboon S., Vogel JP., Moller AB., Lumbiganon P., Petzold M., Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019. 7:e37–46.

Collins A., Weitkamp JH., Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed. 2018. 103:F391–4.

Cotten CM., Taylor S., Stoll B., Goldberg RN., Hansen NI., Sánchez PJ, et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight in-fants. Pediatrics. 2009. 123:58–66.

Fleischmann-Struzek C., Goldfarb DM., Schlattmann P., Schlapbach LJ., Reinhart K., Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018. 6:223–30.

Flidel-Rimon O., Friedman S., Lev E., Juster-Reicher A., Amitay M., Shinwell ES. Early enteral feeding and nosocomial sepsis in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2004. 89:F289–92.

Freeman J., Goldmann DA., Smith NE., Sidebottom DG., Epstein MF., Platt R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N Engl J Med. 1990. 323:301–8.

Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am. 2004. 51:939–59. viii-ix.

Gilfillan M., Bhandari V. Neonatal sepsis biomarkers: where are we now? Res Report Neonatol. 2019. 9:9–20.

Gray JE., Richardson DK., McCormick MC., Goldmann DA. Coa gulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome. Pediatrics. 1995. 95:225–30.

Greenberg RG., Benjamin DK Jr. Neonatal candidiasis: diag-nosis, prevention, and treatment. J Infect. 2014. 69(Suppl 1):S19–22.

Hwang JH., Choi CW., Chang YS., Choe YH., Park WS., Shin SM, et al. The efficacy of clinical strategies to reduce nosoco-mial sepsis in extremely low birth weight infants. J Korean Med Sci. 2005. 20:177–81.

Hylander MA., Strobino DM., Dhanireddy R. Human milk fee-dings and infection among very low birth weight infants. Pediatrics. 1998. 102:E38.

Johnson-Robbins LA., el-Mohandes AE., Simmens SJ., Keiser JF. Staphylococcus epidermidis sepsis in the intensive care nursery: a characterization of risk associations in infants < 1,000 g. Biol Neonate. 1996. 69:249–56.

Kinney MV., Lawn JE., Howson CP., Belizan J. 15 Million preterm births annually: what has changed this year? Reprod Health. 2012. 9:28.

Klein Klouwenberg P., Bont L. Neonatal and infantile immune responses to encapsulated bacteria and conjugate vaccines. Clin Dev Immunol. 2008. 2008:628963.

Klingenberg C., R⊘nnestad A., Anderson AS., Abrahamsen TG., Zorman J., Villaruz A, et al. Persistent strains of coagulase-negative staphylococci in a neonatal intensive care unit: virulence factors and invasiveness. Clin Microbiol Infect. 2007. 13:1100–11.

Kollmann TR., Kampmann B., Mazmanian SK., Marchant A., Levy O. Protecting the newborn and young infant from infectious diseases: lessons from immune ontogeny. Immunity. 2017. 46:350–63.

Lam BC., Lee J., Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics. 2004. 114:e565–71.

Leante-Castellanos JL., Martínez-Gimeno A., Cidrás-Pidré M., Martínez-Munar G., García-Gonzá lez A., Fuentes-Gutiérrez C. Central-peripheral temperature monitoring as a marker for diagnosing late-onset neonatal sepsis. Pediatr Infect Dis J. 2017. 36:e293–7.

Lee WR. Neonatal sepsis. J Korean Pediatr Soc. 2002. 45:289–94.

Liu D., Du L., Yu J., Li L., Ai Q., Feng J, et al. 16S rDNA PCR-DGGE and sequencing in the diagnosis of neonatal late-onset septicemia. Mol Med Rep. 2015. 12:6346–52.

Maródi L., Goda K., Palicz A., Szabó G. Cytokine receptor sig-nalling in neonatal macrophages: defective STAT-1 pho-sphorylation in response to stimulation with IFN-gamma. Clin Exp Immunol. 2001. 126:456–60.

Mithal LB., Yogev R., Palac H., Gur I., Mestan KK. Computerized vital signs analysis and late onset infections in extremely low gestational age infants. J Perinat Med. 2016. 44:491–7.

Molloy EJ., Wynn JL., Bliss J., Koenig JM., Keij FM., McGovern M, et al. Neonatal sepsis: need for consensus definition, collaboration and core outcomes. Pediatr Res. 2020. 88:2–4.

Narendran V., Visscher MO., Abril I., Hendrix SW., Hoath SB. Biomarkers of epidermal innate immunity in premature and full-term infants. Pediatr Res. 2010. 67:382–6.

Neu J. Preterm infant nutrition, gut bacteria, and necrotizing enterocolitis. Curr Opin Clin Nutr Metab Care. 2015. 18:285–8.

Pammi M., Weisman LE. Late-onset sepsis in preterm infants: update on strategies for therapy and prevention. Expert Rev Anti Infect Ther. 2015. 13:487–504.

Pessoa-Silva CL., Hugonnet S., Pfister R., Touveneau S., Dharan S., Posfay-Barbe K, et al. Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics. 2007. 120:e382–90.

Pittet D., Allegranzi B., Boyce J; World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol. 2009. 30:611–22.

Raymond SL., Mathias BJ., Murphy TJ., Rincon JC., López MC., Ungaro R, et al. Neutrophil chemotaxis and transcriptomics in term and preterm neonates. Transl Res. 2017. 190:4–15.

Shane AL., Sánchez PJ., Stoll BJ. Neonatal sepsis. Lancet. 2017. 390:1770–80.

Shane AL., Stoll BJ. Recent developments and current issues in the epidemiology, diagnosis, and management of bacterial and fungal neonatal sepsis. Am J Perinatol. 2013. 30:131–41.

Shim SY., Cho SJ., Park EA. Neurodevelopmental outcomes at 18-24 months of corrected age in very low birth weight infants with late-onset sepsis. J Korean Med Sci. 2021. 36:e205.

Sisk PM., Lovelady CA., Dillard RG., Gruber KJ., O'Shea TM. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007. 27:428–33.

Statistics Korea. Statistics by theme [Internet]. Daejeon (Korea): Statistics Korea;2020. [cited 2021 Aug 25]. Available from: https://kosis.kr/statisticsList/statisticsListIndex.do?vwcd=MT_ZTI%20TLE%20&menuId=M_01_01&outLink=Y&entrType=#content-group.

Stoll BJ., Hansen N., Fanaroff AA., Wright LL., Carlo WA., Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002. 110(2 Pt 1):285–91.

Stoll BJ., Hansen NI., Adams-Chapman I., Fanaroff AA., Hintz SR., Vohr B, et al. Neurodevelopmental and growth impair-ment among extremely low-birth-weight infants with neo natal infection. JAMA. 2004. 292:2357–65.

Stuber E., Strober W., Neurath M. Blocking the CD40L-CD40 interaction in vivo specifically prevents the priming of T helper 1 cells through the inhibition of interleukin 12 se-cretion. J Exp Med. 1996. 183:693–8.

Wynn JL. Defining neonatal sepsis. Curr Opin Pediatr. 2016. 28:135–40.