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Children's Health

Staph infections in premature babies

09/25/2006

Question:

My niece is almost two weeks old and we just found out she has a staph infection in her abdomen and she is not going to make it. My question is,what causes staph infections in premature babies?

Answer:

I am so sorry your new niece is so gravely ill.

Staphylococcus aureus is the most cause of newborn skin infections. Many factors come together to make preterm infants extremely vulnerable to infection. The first factor is simply that of preterm birth. A subtle infection of the mother or her placenta can trigger preterm birth. The doctors caring for preterm infants assume that infection is highly likely and treat the baby with broad spectrum antibiotics after culturing the baby for bacteria. They continue to treat the baby until culture results prove the baby is not infected. They do this because an infection can overwhelm and kill a preterm or term infant within hours of birth. The prevailing wisdom, and standard of care, is that the possibility of benefit to the baby from early treatment for infection is far greater than the risk of harm from a delay in treatment, which could allow bacteria time to overwhelm the baby's immune defenses.

The second factor is the risk of treatment with antibiotics. Antibiotics are chosen to attack the most likely bacteria that cause newborn illness. They also destroy many of the "good bacteria" that live on the skin and in our bodies, keeping illness-causing bacteria numbers in check and preventing infection.

The third factor is the greatly reduced function of the newborn infant's immune system, which is even more vulnerable in preterm infants than term infants. It is simply no match for the pathogens in our very dirty world from which they are protected while inside their mothers. Because their immune systems have not encountered the bacteria in our environment, their bodies do not recognize them and attack them as effectively as do the immune systems of older children and adults. This is why  doctors and nurses urge family members to wash their hands well before touching a new baby and to avoid exposing the baby to sick people. They know newborns become ill far more easily and are far sicker when they do become ill.

The fourth factor is the greater number of seriously pathogenic bacteria in our hospital settings. Every time a baby has blood drawn, even by a heelstick, or gets an IV or has to be suctioned or placed on a ventilator, the natural barrier defenses of the baby's body are breached. If we don't do these things, the baby can die of dehydration or respiratory arrest, but if we do them or even if we just keep the baby in the hospital, we expose the baby to illness-causing bacteria despite our best efforts to protect the baby.

Infections of the umbilical area are not uncommon in newborns and most infants treated early with antibiotics do very well. However, preterm infants with infections are far more easily overwhelmed by infection despite the aggressive use of antibiotics.

I hope this information helps you understand a very sad experience in your family's life.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University