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IS-013 Neonatal Sepsis, New Preventive Strategies
  1. A Borghesi1,
  2. I Mazzucchelli2,3,
  3. M Pozzi4,
  4. L Bollani4,
  5. M Stronati1
  1. 1Neonatologia Patologia Neonatale e Terapia Intensiva and Laboratory of Neonatal Immunology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  2. 2Laboratory of Neonatal Immunology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  3. 3Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
  4. 4Neonatologia Patologia Neonatale e Terapia Intensiva, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Abstract

Severe infections represent the main cause of neonatal mortality, accounting for more than 1 million neonatal deaths worldwide every year.

Late-onset infections (occurring after the first 72 h of life) are thought to be caused by horizontally transmitted microorganisms, and may be 1) nosocomial, occurring during hospital stay in NICU, or 2) non-nosocomial, affecting home discharged, otherwise healthy full-term neonates.

1) Strategies to reduce the incidence of infection in NICU include

i) Reduction of the exposition of newborn infants to pathogens: hand hygiene practices; proper management of central lines; promotion of early enteral feeding with human milk; prophylaxis with lactoferrin and fluconazole;

ii) Improvement of neonatal defenses: lactoferrin and human milk. Cytokines/growth factors (e.g., GM-CSF), and other immune therapies (intravenous Ig, monoclonal anti-staphylococcal antibodies) are currently not recommended for neonates. Future strategies may include: the development of highly specific, broadly neutralising antibodies to be used in high risk infants; and maternal immunisation practices to prevent both late-onset infection and early-onset infection and/or infection-related preterm birth.

iii) Identification of high risk infants: this is a central point including, but not limited to, the use of metabolomics for risk stratification.

2) Strategies to prevent infections in otherwise healthy, home discharged full-term neonates

These infections are almost always unpredictable and often severe; future research should focus on the identification of high-risk infants, in order to implement preventive protocols; and on maternal immunisation against common pathogens as a general practice to reduce neonatal vulnerabilty.

Abstract IS-013 Figure 1

A comprehensive view of the strategies for the prevention of neonatal infections

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