OVERVIEW

How are newborns defined?

A newborn refers to a baby within 28 days after birth, roughly equivalent to the colloquial term "baby under one month old."

What is neonatal hospital-acquired infection?

Infectious diseases are illnesses caused by pathogens such as bacteria, viruses, or mycoplasma invading and proliferating in the human body.

Neonatal hospital-acquired infection, also known as "nosocomial infection in newborns," refers to newly acquired infectious diseases during hospitalization in neonates admitted for various conditions. It excludes infections present at admission or those in the incubation period.

Common neonatal hospital-acquired infections include: neonatal sepsis, neonatal pneumonia, neonatal purulent meningitis, neonatal infectious enteritis, neonatal necrotizing enterocolitis, etc. Symptoms may include hypothermia or fever, intense crying, rapid breathing, vomiting, diarrhea, and more.

Timely diagnosis and prompt anti-infective treatment are crucial. More importantly, hospitals and doctors should strive to reduce the incidence of hospital-acquired infections.

Are neonatal hospital-acquired infections common?

Yes.

International statistics show that the incidence of neonatal hospital-acquired infections in neonatal intensive care units (NICUs) ranges from 6% to 22%, while in general neonatal wards, the rate is 0.3% to 1.7%, mostly involving mild infections. This is largely due to the severe conditions and poor baseline health of NICU patients.

SYMPTOMS

What are the manifestations of hospital-acquired infections in newborns?

Symptoms may include failure to cry, hypothermia, fever, decreased milk intake, intense crying, rapid breathing, cyanosis, vomiting, abdominal distension, diarrhea, bloody stools, and coughing. These are all nonspecific symptoms, making early detection difficult. Without timely treatment, symptoms will gradually worsen over time.

CAUSES

What are the common pathogenic bacteria causing hospital-acquired infections in newborns?

The pathogens causing infections include bacteria, viruses, fungi, etc.

• Common bacteria include: Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa. Most are drug-resistant bacteria, making them less responsive to conventional antibiotic treatments.

• Common fungi include: Candida.

• Common viruses include: Rotavirus, respiratory viruses, enteroviruses, varicella-zoster virus, etc.

Which newborns are more prone to hospital-acquired infections (nosocomial infections)?

Newborns have immature immune systems and weaker immune function. The likelihood of nosocomial infections increases under the following conditions:

• Low birth weight: Defined as a birth weight less than 2500 g.

• Central venous catheter placement: A central venous catheter is a long-term intravenous line that reduces the need for repeated needle insertions, ensuring adequate nutrition and medication for critically ill or premature infants. However, improper care can introduce pathogens through the catheter, increasing infection risks.

• Intravenous nutrition: When newborns cannot feed orally due to prematurity or other reasons, doctors provide nutrients intravenously. Prolonged use of intravenous nutrition raises infection risks.

• Mechanical ventilation: For newborns with respiratory issues, ventilators assist breathing and oxygenation. Long-term ventilator use increases infection risks.

• Antibiotic use: Prolonged antibiotic use elevates the risk of opportunistic infections, such as fungal infections.

In general, the lower the birth weight, gestational age, or overall health status, and the more intensive the medical interventions, the higher the risk of nosocomial infections.

What are the hospital-related causes of nosocomial infections in newborns?

• Poor hand hygiene: Healthcare workers must wash hands before and after patient contact to prevent pathogen transmission. Non-compliance increases infection risks.

• Improper ward layout: Neonatal wards have strict regulations on bed numbers and spacing. Overcrowding raises infection rates.

• Inadequate disinfection: All instruments and surfaces involved in invasive procedures (e.g., blood draws, IVs, lumbar punctures) must be strictly sterilized. Daily items like bottles and nipples should also follow disinfection protocols.

• Non-standard isolation: Patients infected with multidrug-resistant bacteria should be isolated to limit transmission. Failure to isolate properly increases infection risks.

In reality, China has detailed and strict hospital infection control guidelines. Poor implementation of these measures increases the likelihood of nosocomial infections.

DIAGNOSIS

What tests are needed for hospital-acquired infections in newborns?

• Blood tests: Including complete blood count (CBC), C-reactive protein (CRP), procalcitonin (PCT), blood culture, etc., to assess infection severity and identify pathogens.

• Pathogenic tests: Depending on the suspected infection site, tests such as sputum culture, stool culture, urine culture, cerebrospinal fluid (CSF) culture, or fluid aspiration culture may be performed to identify the exact pathogen. Antimicrobial susceptibility testing can also be conducted simultaneously to guide subsequent treatment.

• X-ray imaging: Such as chest X-ray or abdominal X-ray. These can evaluate lung or intestinal conditions when pneumonia or enteritis is suspected and may also be used for dynamic monitoring of the disease.

• Chest CT scan: CT provides clearer images than X-rays but exposes the child to more ionizing radiation. For newborns, low-dose CT protocols can be used. Chest CT may be considered for complex or recurrent lung infections, suspected lung abscesses, or pulmonary/airway malformations. If the doctor deems a CT necessary, parents should not outright reject it but instead discuss the benefits and necessity with the physician to make an informed decision. The radiation dose from a single CT scan is far below the threshold for causing harm to the human body.

• Ultrasound: A commonly used non-invasive test to examine the structure and function of thoracic and abdominal organs. If infection in these areas is suspected, an ultrasound may be required.

• Cerebrospinal fluid (CSF) examination: If purulent meningitis or other intracranial infections are suspected, a lumbar puncture is performed to collect CSF for analysis. CSF, like saliva or gastric fluid, is continuously produced, and extracting a few milliliters for testing will not harm the body. The procedure does not involve contact with bones and will not cause back pain in adulthood, so excessive worry is unnecessary. Doctors will obtain additional parental consent before performing a lumbar puncture. Parents with concerns should discuss them with the doctor before signing. If the test is medically necessary, it is advisable to follow the doctor's recommendation.

TREATMENT

Which department should I visit for neonatal hospital-acquired infections?

Neonatology.

Neonatal hospital-acquired infections occur within the hospital, and the attending physician will arrange examinations and treatment for you. If the baby is in the NICU (Neonatal Intensive Care Unit), due to current limitations in most hospitals in China, parents are not allowed to enter the ward to accompany their child.

How is neonatal hospital-acquired infection treated?

Treatment mainly involves anti-infective measures, selecting appropriate anti-infective drugs based on different pathogens. Additionally, it includes symptom relief (such as fever reduction, pain relief, asthma control, and phlegm reduction), maintaining internal balance (such as fluid and potassium supplementation), and managing complications. Specific treatment methods can be found under each respective disease.

DIET & LIFESTYLE

How to Care for Newborns with Hospital-Acquired Infections in Terms of Life and Diet?

If the baby can eat orally, breast milk remains the best choice. There are only rare cases where newborns cannot be breastfed, including mothers with HIV, active tuberculosis, or babies with rare inherited metabolic disorders such as phenylketonuria or galactosemia.

If the baby needs to stay in an unaccompanied NICU, the mother's milk supply may be affected due to the emotional distress caused by separation and unpredictable changes in the baby's condition. Family members should encourage and assist the mother in maintaining her milk supply.

For newborns, breast milk is superior to formula in all aspects, so efforts should be made to sustain breastfeeding. An electric breast pump and breast milk storage bags can be used to freeze and store breast milk, which can then be delivered to the hospital ward for the baby if conditions permit.

PREVENTION

How to Prevent Hospital-Acquired Infections in Newborns?

Reducing hospital-acquired infections in newborns primarily relies on the efforts of hospitals and healthcare professionals.

• Strictly adhere to infection control protocols, with particular emphasis on hand hygiene.

• Use antibiotics rationally to avoid excessive or inappropriate use, which can increase antibiotic resistance and the risk of fungal infections.

• When medically feasible, resume enteral feeding for the baby as early as possible and avoid prolonged fasting to reduce the risk of gastrointestinal infections.

• Protect the newborn's skin to prevent breaks, injuries, or exposed wounds, which may increase infection risks.

• Properly manage indwelling devices such as ventilator tubes, urinary catheters, and central venous catheters to minimize the risk of hospital-acquired infections.