Infection prevention for extremely low birth weight infants in the NICU

Area of Science:

• Neonatalogy
• Infectious Disease Prevention
• Pediatric Critical Care

Background:

• Extremely preterm infants possess immature immune systems, increasing susceptibility to systemic infections.
• Factors like prolonged hospitalization, delayed feeding, antibiotic use, and invasive procedures exacerbate infection risk.
• The global SARS-CoV-2 pandemic introduced new challenges and prevention strategies in Neonatal Intensive Care Units (NICUs).

Purpose of the Study:

• To examine the susceptibility of preterm infants to invasive infections.
• To describe current and emerging strategies for infection prevention in this vulnerable population.
• To identify knowledge gaps and the need for further research, including multi-center randomized controlled trials.

Main Methods:

• Review of evidence-based practices for infection prevention in extremely preterm infants.
• Analysis of the risks and benefits of controversial interventions like probiotics and human milk-derived fortifiers.
• Discussion of the impact of the SARS-CoV-2 pandemic on NICU infection control.

Main Results:

• Established practices include human milk feedings, bundle checklists, and pathogen decolonization.
• Probiotics, human milk-derived fortifiers, and antifungal prophylaxis show potential but require further risk-benefit analysis.
• The chapter highlights limitations of current practices and significant gaps in understanding infection prevention.

Conclusions:

• Infection prevention in extremely preterm infants requires a multifaceted approach, balancing established and emerging strategies.
• Further large-scale, multi-center randomized controlled trials are crucial to guide evidence-based practices.
• Adapting infection prevention protocols to novel challenges, such as pandemics, is essential for improving outcomes.