Systemic infections are an important cause of morbidity and mortality in premature babies. These infections are divided into 2 groups, differing both in terms of etiology and clinical results:

Early infections in premature infants are represented by bacteremia, pneumonia, meningitis and urinary tract infections. These infections rarely develop, are characterized by a severe course and can lead to disability. Mortality due to early infections reaches 40%, which is 3 times higher than that of premature babies in the absence of infection.

Their main agents responsible for infection in premature babies are group B streptococci and Escherichia coli. Risk factors for the development of early infections caused by group B streptococci include:

In recent decades, in many economically developed countries, in the context of extensive antibiotic prophylaxis during childbirth, the incidence of newborns with streptococcal infections has decreased and the incidence of infections caused by Gram negative intestinal flora increased.

In most children, an early systemic infection occurs within the first 12 hours of life, but symptoms may occur later, especially if the mother has received antibiotic therapy. The development of infection is accompanied by the following clinical manifestations:

Empirical antibiotic therapy is prescribed for all newborns with symptoms of sepsis, as well as those with a history of factors with an increased risk of infection. The drugs of choice are penicillin in combination with aminoglycosides (gentamicin). In the absence of clinical manifestations of infection, as well as a negative result of the bacteriological examination of the blood, urine and cerebrospinal fluid, treatment is stopped after 48 hours. When bacteremia is confirmed, parenteral administration of antibiotics continues for up to 14 days, in patients with meningitis - up to 3 weeks.

Late infections quite often develop in premature infants (up to 20% of infants with low body weight).

Infections are usually caused by the nosocomial flora, the main pathogens are:

The risk of developing an infection is inversely proportional to gestational age and body weight at birth and is directly proportional to the severity of the condition of the newborn.

Late systemic infections are characterized by the following clinical manifestations:

Laboratory results include a change in white blood cell count, unexplained metabolic acidosis, and hyperglycemia.

If an infection is suspected, a culture study of body fluids is performed. Antimicrobial agents begin immediately after sampling for research. Upon receipt of a negative result, the processing is canceled. The drugs of choice for the empirical treatment of suspected nosocomial sepsis in premature infants are antistaphylococcal antibiotics and aminoglycosides. With confirmation of the etiological role of coagulase negative staphylococci, as well as with the ineffectiveness of antistaphylococcal penicillins, vancomycin or teicoplanin is indicated.

Late infections are generally characterized by a favorable clinical course, with the exception of those caused by intestinal and fungal Gram-negative flora, the mortality rate of which remains fairly high.

Risk factors for the development of invasive fungal infections in premature babies are:

The clinical manifestations of invasive fungal infections are similar to those of bacterial infections, which can complicate the diagnosis.

Therapy is carried out with drugs such as amphotericin B (including liposomal), flucytosine, triazoles (fluconazole, itraconazole) and imidazoles (miconazole, ketoconazole). Although systemic antifungal therapy is often prescribed before the diagnosis is confirmed, the mortality rate from these infections in premature babies exceeds 30%. Local (nystatin) and / or systemic (fluconazole) prophylaxis is believed to help reduce the risk of fungal infections.

The appointment of concomitant non-antibacterial therapy may, according to some authors, help reduce mortality from infections in premature infants. To this end, it is proposed to use drugs such as:

Measures to prevent the development of infections are reduced to careful observation of the rules of asepsis and antiseptics. Treating hands with alcohol after each contact with newborns has been shown to significantly reduce the risk of developing infections compared to washing them with soap. Measures such as the wearing of gloves, caps and medical masks by staff and parents are significantly less effective. The prophylactic use of antibiotics is not indicated, as it contributes to the development of a resistant flora.