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[Causes of and change in bacterial infections in newborn infants]
1Universitäts-Kinderklinik Würzburg.
Insights
Neonatal bacterial infections remain a significant threat, with premature infants being most vulnerable. Understanding evolving bacterial spectra and transmission routes is crucial for combating rising morbidity and mortality rates in newborns.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Microbiology
Context:
- Despite advances in neonatology, bacterial infections in newborns are increasing.
- Premature infants exhibit heightened vulnerability to infections, escalating with immaturity.
- Infections account for 10-20% of neonatal deaths.
Purpose:
- To explore the reasons behind increased neonatal bacterial infections.
- To analyze the changing bacterial spectrum and infection channels over 60 years.
- To highlight the critical need for vigilance and knowledge in neonatal infection control.
Summary:
- Bacterial spectra have shifted from Gram-positive cocci to Gram-negative enterobacteriaceae and now to coagulase-negative staphylococci, often linked to nosocomial infections.
- Vertical transmission from mothers is a primary concern, particularly for preterm infants.
- Group B streptococci pose the greatest threat, causing pneumonia and respiratory distress syndrome (RDS).
Impact:
- Enhanced understanding of neonatal infection dynamics is vital for clinical practice.
- This knowledge aids in developing targeted prevention and treatment strategies.
- Proactive monitoring of bacterial trends can reduce neonatal morbidity and mortality.
Abstract:
Despite all the progress made in modern neonatology the morbidity rate caused by bacterial infections has rather gone up than down. The reasons why premature and newborn infants have a greater disposition to bacterial infections have been largely explored; at the same time one must accept these infants to be increasingly vulnerable to infections, the vulnerability being the larger the greater the degree of immaturity is. Every 5th to 10th death of newborn infants is caused by infection. One will have to be constantly on the watch and acquire profound knowledge of channels of infection and the bacterial spectrum to be expected. Since the early beginnings of neonatology, some 60 years ago, a continuous change in bacterial spectra has been going on showing incredible regularity in crossing even borders and continents. With gram-positive cocci (A streptococci) prevailing at the beginning, there was a considerable increase in gram-negative enterobacteriaceae in the 60ies and 70ies, when neonatal intensive medicine was started. There were mainly nosocomial infections resulting from too generously administered antibiotics. Today, plasmacoagulase-negative staphylococci, for a long period thought not to be pathogenous, are the essential bacteria in nosocomial infections. On the whole, one usually has to do with infections vertically transmitted by the mother, especially to preterm infants. The greatest threat still comes from B streptococci since they will lead to pulmonary changes such as pneumonia and RDS. The development reported on is based on data from the literature and my own experience as well as on comprehensive results of the Neonatalerhebung of Lower Saxony and Bavaria.