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Understanding Neonatal Infections: Vulnerability and Prevention

Discover why premature infants are more susceptible to infections, the clinical manifestations, and preventive measures. Explore the neonatal immune system and barriers to infections. Etiologic agents of neonatal sepsis and meningitis.

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Understanding Neonatal Infections: Vulnerability and Prevention

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  1. Neonatal Infections

  2. Questions? • Why are infants, especially prematures, more susceptible to infections? • What are the clinical manifestations of neonatal infections? • Bacterial? Viral? • How to prevent infections?

  3. “Prematurity is an infectious disease.” - James Todd, M.D.

  4. Why are infants, especially premies, more susceptible to infections?

  5. Neonatal Immune System • All neonates relatively immunocompromised • Immature and Ineffective: • Antibodies • Complement • Neutrophils • Skin / mucosal barriers

  6. Antibody

  7. Antibodies  Infectious agent   Immunity Figure 1.1 Antibodies (anti- foreign bodies) are produced by host while cells on contact with the invading micro-organism which is acting as an antigen (e.g. generates antibodies). The individual may then be immune to further attacks. (Modified From: Roitt, I: Essential Immunology, 4th edition, Blackwell Scientific Publications, 1980)

  8. Antibodies  Infectious agent   Immunity x x No contact with infectious agents = no antibody production

  9. Maternal Transfer of Antibodies • Antibody transfer increases with GA • Most during 3rd trimester • No guarantee maternal antibodies present to the infecting organism Remington and Klein, Sixth Edition, 2006

  10. Complement

  11. Neutrophils

  12. Neonatal Neutrophils • Immature •  Chemotaxis •  Deformability •  Phagocytosis •  Storage pool • Adults 14-fold > circulating pool • Neonates only 2-fold

  13. “Normal” VLBW neonates Mouzinho et al, Pediatr 94:76, 1994

  14. “Normal” VLBW neonates Mouzinho et al, Pediatr 94:76, 1994

  15. Neonatal Barriers to Infection

  16. Neonatal Anatomic Barriers • Immature skin and mucosal surfaces • layers • junctions between cells • secretory IgA • Umbilical cord • Breaches - catheters, tape

  17. Invasive Fungal Dermatitis in a VLBW infant JL Rowen, Sem Perinatal 27:406-413, 2003

  18. Epidemiology

  19. Neonatal Sepsis: Incidence • 2/1000 live births with culture proven sepsis • Bacterial / Viral / Fungal • 80% infants develop bacterial sepsis • 20% infants perinatally acquired viral infections • ~ 25% of infected infants have meningitis • Higher rate with preterm birth • 26/1000 preterm infants with BW < 1000g • 8-9/1000 preterm infants with BW 1000-2000g Remington and Klein, Sixth Edition, 2006

  20. Neonatal Infections Sepsis Meningitis Pneumonia Otitis Media Diarrheal Disease UTI Osteomyelitis Suppurative Arthritis Conjunctivitis Orbital Cellulitis Cellulitis - - Omphalitis Bacterial / Viral / Fungal

  21. Etiologic Agents of Neonatal Sepsis

  22. Etiologic Agents of Neonatal Meningitis

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