Nosocomial Infections in the Neonatal Intensive Care Unit

Objectives

After completing this article, readers should be able to:

1. List the primary pathogens involved in late-onset infections.

2. List the major risk factors for nosocomial sepsis.

3. Describe practices that can reduce the risk of nosocomial infections.

Introduction

Improvements in antenatal management and neonatal intensive care over the past 10 to 15 years have changed the prognosis for preterm infants. More than 85% of infants born at 25 weeks’ gestation now survive their preterm birth. This has resulted in a dramatic change in the populations of infants occupying neonatal intensive care beds. The average length of stay for a term or near-term infant who has surgical or respiratory problems is about 15 days; the length of stay for preterm infants born at 26 weeks’ gestation is more than 2 months. The duration of hospitalization is inversely related to gestational age.

The population of extremely low-birthweight (ELBW) infants who remain hospitalized for extended periods of time (and who undergo numerous invasive procedures) is most susceptible to nosocomial infections. Nosocomial infections are defined as those that occur beyond 48 hours after birth and are caused by pathogens that are not maternally derived. Such infections are 100 times more common than early-onset bacterial infections, which are caused by pathogens acquired in utero or perinatally. Recent data from the National Institute of Child Health and Human Development-sponsored “Neonatal Network” indicated that 29% of infants born at 25 to 28 weeks’ gestation and 46% of infants born at less than 25 weeks’ gestation experience a serious nosocomial infection during hospitalization in the NICU.

The morbidity and mortality from nosocomial infections is enormous. In the United States, more than 2,000,000 nosocomial infections (in infants and adults) occur each year, and 50% to 60% are caused by resistant organisms. It has been estimated that 9,600 to 20,000 patients die each …