Premature Infants Are at Risk for Infections that Can Prolong Hospitalization and Delay Recovery([FOOTNOTE=Hooven TA, Polin RA. Healthcare-associated infections in the hospitalized neonate: a review. Early Hum Dev. 2014;90(S1):S4-S6.],[ANCHOR=],[LINK=])

Infection risk is high because preterm infants have immature immune defenses, skin that is not fully developed and limited protective flora.1,([FOOTNOTE=Polin RA, Denson S, Brady MT, et al. Epidemiology and diagnosis of health care–associated infections in the NICU. Pediatrics. 2012;129(4):e1104-e1109.],[ANCHOR=],[LINK=]) They frequently need invasive procedures1 and may have in-dwelling catheters and tubes that act as portals to bring pathogens across protective barriers.2

The Most Common Infections

The most common hospital-acquired NICU infections are bloodstream infections associated with the use of catheters.2,([FOOTNOTE=Polin RA, Denson S, Brady MT. Strategies for prevention of health care-associated infections in the NICU. Pediatrics. 2012:129:e1085-1093.],[ANCHOR=],[LINK=]) Lower respiratory tract infections and ventilator-associated pneumonia are frequent and can potentially be severe.2 These hospital-acquired infections can set back a neonate on the road to recovery.1

3X the Infections

Very low-birth-weight premature neonates have 3x the infections as heavier babies.2

The Fragile Skin

The skin of premature neonates is not fully formed — it is approximately 40% to 60% thinner than adult skin — and not as capable of providing protection against environmental stressors.([FOOTNOTE=McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. Orthop Nurs. 2013;32(5):267-281.],[ANCHOR=],[LINK=]),([FOOTNOTE=Visscher M, Narendran V. The ontogeny of skin. Adv Wound Care. 2014;3:291-303.],[ANCHOR=],[LINK=]) Neonates commonly develop skin and soft-tissue infections.1 In addition, poor skin integrity is also a major risk factor for neonatal sepsis.5

The premature epidermis is protected by few cornified layers, and the dermis lacks structural proteins found in full-term skin.5 As a result, premature skin is more permeable to infectious agents and irritants, has poor mechanical properties and is easily damaged.5 Consequently, a procedure as routine as adhesive removal can damage premature neonatal skin.5 Cellulitis, abscesses, and abrasions may occur where lancets are used or electrodes are applied. Skin damage or infections may also occur under diapers or bandages.2

34-35 Weeks

The skin's protective outer layer is not fully formed until 34-35 weeks of gestation.5