Antibiotic resistance is on the rise in the United States, and, with it, the increased risk of serious infections in hospitals. Unfortunately, infections and antimicrobial resistance pose a profound threat to some of the hospital’s most vulnerable inpatients—newborns. Many patients in the neonatal intensive care unit (NICU) are premature and their immune systems are weak, so we take extra care to protect them.

We keep a detailed database of types of infections, tracking the latest trends and the newest strains. As a result, we're able to use antibiotics in a targeted way.

The NICU is the area of the hospital where newborn babies with health concerns receive comprehensive care.

There are several reasons why babies in the neonatal intensive care unit are at risk for infection. Many NICU newborns are premature and, as a result, their immune systems are immature and weak. Those babies are also typically in the hospital for prolonged periods of time. As with any sustained hospitalization, necessary medical interventions may carry a risk of infection.

Bacterial infections are the most common NICU infections. They fall in two main categories:

• Infections that are acquired during the labor and birth process
• Hospital-acquired infections that babies contract while they are patients in the NICU

Hospital-acquired infections can come from the environment—for example, from some of the support devices, such as central lines for administering medication or fluids or from breathing tubes, which are used to keep these babies alive.

MRSA, which stands for Methicillin-resistant Staphylococcus aureus, is a hospital-acquired infection that is becoming more common, and which is resistant to antibiotics.

“This bacteria is very difficult to treat with the typical antibiotics that we have available to us and that we would typically use,” says Matthew Bizzarro, MD, a physician in the Neonatal-Perinatal Medicine Section at Yale Medicine. "Once a patient becomes infected with a resistant strain of bacteria, it becomes very difficult to treat that individual."

While these infections are treated with antibiotics, the antibiotics used can be different than they are for adults, due to the risk of potential side effects with certain drugs when administered to newborns.

Initial treatment courses are geared toward the bacteria that most commonly cause infection in newborn babies, such as Group B streptococcus (GBS), which are sometimes different from the types of bacteria that cause infection in adults.

Treatments can sometimes last for weeks, depending on the nature of the infection and the severity of illness in the newborn.

Prematurity is the major risk factor for developing an infection in the NICU. One of the best barriers to infection is skin, and the skin of the premature newborn is often underdeveloped.

"With that barrier all but lost, it makes it very easy for infections to get inside the body,” says Dr. Bizzarro.

Once a newborn acquires an infection, there's a significant risk  of developing a lot of health problems, some of them serious and even potentially fatal. Babies that survive infection also face an increased risk of having problems when they get older, such as developmental and growth delays and impairments.

Parents play a very important role in infection prevention. By practicing good hand hygiene and monitoring the hand hygiene of the care team, parents can greatly lessen the risk of their children contracting an infection.

Agreeing to and allowing timely vaccinations, even in the neonatal intensive care unit, is another very important way parents that can assist in preventing infection.

Yale Medicine has one of the most extensive databases concerning infections, with record keeping dating back to 1928, and our researchers have published multiple papers that examine the changes to neonatal infections over time.

Having this information on hand allows care teams to very quickly identify trends as they happen, not only in the types of bacteria that cause NICU infection but also in some of the risk factors for infection. In turn, that has allowed us to develop programs to more effectively identify and prevent infections.

In 2007, we discovered that central lines were the primary source of most hospital acquired infections in the NICU. We put together a multidisciplinary team to improve insertion and care of central lines. This effort resulted in a reduction in bloodstream infections in the NICU by approximately 80 percent.

Low birth weight babies in the NICU will develop at least one infection before they leave. In our neonatal intensive care unit, infection rates are considerably lower—at 7 percent.

We share knowledge of how achieved these improvements with the wider medical community, so they can adopt proven techniques and approaches.

“There’s nothing more rewarding than to be able to have a dramatic impact on the lives of the families and the babies that you take care of, and then to be able to publish that and have other people adopt similar strategies with successes on a wider scale,” says Dr. Bizzarro.