Infection control practices and immune modification to prevent nosocomial sepsis in hospitalized newborn infants

The incidence of nosocomial septicemia is extremely common in immature, newborn infants receiving intensive care. Developmental facets of host defense, medical interventions, and the hospital environment contribute to the septicemia rate exceeding 40% in extremely low birth weight infants. There is growing evidence that multifaceted, collaborative quality improvement measures may decrease infection rates; however, the effective implementation of these measures requires introspection and detailed analysis of hospital-specific infection control practices. Immune augmentation with human milk has been shown to effectively reduce nosocomial infections. The efficacy of pharmacologic agents such as polyclonal intravenous immune globulin and colony stimulating factors to reduce nosocomial infections has been mixed. Systemic antimicrobial prophylaxis may decrease staphylococcal and Candida spp infection rates in hospitalized infants, but this therapy carries the risks of alteration in host microbial flora as well as the development of antimicrobial resistance. Specifically targeted immunotherapy with hyperimmunoglobulin preparations, monoclonal antibodies and probiotics are currently being investigated and may become effective tools to reduce nosocomial infections in the future.