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Hospital-acquired infections in preterm infants with gestational age <32 weeks: a retrospective study of clinical

Yi-Mei Yang1, Yan Dai1, Yu-Yan Xie1

  • 1Department of Pediatrics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.

Frontiers in Pediatrics
|June 30, 2026
PubMed

Insights

Nosocomial infections affect one-third of very preterm infants. Peripherally inserted central catheter (PICC) use and vitamin D deficiency increase risk, while delayed cord clamping (DCC) is protective, suggesting targets for prevention.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Public Health

Background:

  • Very preterm infants (<32 weeks' gestation) are highly susceptible to nosocomial infections due to immature immune systems and intensive care interventions.
  • Limited data exist on the epidemiology and modifiable risk factors for infections in Chinese neonatal intensive care units (NICUs).

Purpose of the Study:

  • To investigate the incidence, characteristics, and risk factors of nosocomial infections in preterm infants (<32 weeks' gestation) in a Chinese NICU.
  • To identify modifiable factors for infection prevention in this vulnerable population.

Main Methods:

  • A retrospective cohort study of 170 preterm infants (<32 weeks' gestation) admitted to a NICU between January 2022 and December 2024.
  • Epidemiological data, including infection sites and pathogens, were collected. Risk and protective factors were analyzed using logistic regression, with model discrimination assessed by ROC curve analysis.
  • Outcomes such as bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), brain injury, and mortality were compared between infected and non-infected infants.

Main Results:

  • Nosocomial infections occurred in 31.18% of infants, with a rate of 35.88% per episode. Respiratory tract infections, particularly pneumonia, were most common.
  • Gram-negative bacteria were predominant pathogens. Peripherally inserted central catheter (PICC) use (aOR=3.172) and 25-hydroxyvitamin D deficiency (aOR=2.867) were independent risk factors.
  • Delayed cord clamping (DCC) was independently protective (aOR=0.265). BPD incidence was significantly higher in infected infants (47.17% vs. 29.91%, P=0.029).

Conclusions:

  • Approximately one-third of very preterm infants in this cohort acquired nosocomial infections.
  • PICC catheterization, vitamin D deficiency, and DCC are modifiable factors associated with infection risk.
  • Standardizing PICC care, ensuring adequate vitamin D levels, and implementing DCC are potential strategies for infection prevention in preterm infants.
Abstract

Keywords:
delayed cord clampinginfantnosocomial infectionperipherally inserted central catheterprematurerisk factorsvitamin D deficiency

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