No abstract

Breast milk has always been the best source of nourishment for newborns. However, breast milk can carry a risk of infection, as it can be contaminated with bacterial or viral pathogens. This paper reviews the risk of acquisition of varicella-zoster virus (VZV) and cytomegalovirus (CMV), herpesviruses frequently detected in breastfeeding mothers, via breast milk, focusing on the clinical consequences of this transmission and the possible strategies for preventing it. Maternal VZV infections are conditions during which breastfeeding may be temporarily contraindicated, but expressed breast milk should always be given to the infant. CMV infection acquired through breast milk rarely causes disease in healthy term newborns; an increased risk of CMV disease has been documented in preterm infants. However, the American Academy of Pediatrics (AAP) does not regard maternal CMV seropositivity as a contraindication to breastfeeding; according to the AAP, in newborns weighing less than 1500 g, the decision should be taken after weighing the benefits of breast milk against the risk of transmission of infection. The real efficacy of the different methods of inactivating CMV in breast milk should be compared in controlled clinical trials, rigorously examining the negative consequences that each of these methods can have on the immunological and nutritional properties of the milk itself, with a view to establish the best risk-benefit ratio of these strategies before they are recommended for use in clinical practice. RiassuntoIl latte materno rappresenta da sempre il migliore alimento per il neonato. Esso, tuttavia, può comportare un rischio infettivo, in quanto può essere contaminato sia da agenti batterici sia da agenti virali. Lo scopo di questa revisione è quello di descrivere lo "stato dell'arte" sul rischio di trasmissione con il latte materno degli herpesvirus di più frequente riscontro nella donna che allatta: varicella-zoster virus (VZV) e cytomegalovirus (CMV), sulle conseguenze cliniche di questa trasmissione e sulle possibili strategie di prevenzione. Per quanto riguarda l'infezione da VZV, le linee guida formulate per l'Unione Europea, che raccomandano di separare la madre con varicella in atto dal neonato durante la fase contagiosa, ma di alimentare sempre ed esclusivamente il neonato protetto con le immunoglobuline specifiche anti-VZV con il latte materno spremuto, appaiono appropriate, in quanto tengono in considerazione sia il rischio potenziale di acquisire una varicella postnatale sia gli innumerevoli benefici del latte materno. Per quanto riguarda l'infezione da CMV, allattare o no con latte materno i neonati prematuri nati da madre CMV-positiva rimane ad oggi una questione controversa. L'Accademia Americana di Pediatria considera la sieropositività materna per CMV come una condizione che non controindica l'allattamento materno, anche nei neonati prematuri. I diversi metodi di inattivazione del CMV nel latte umano dovrebbero essere confrontati in trials clinici controllati, valutando rigorosamente le r...

Outbreaks of nosocomial pathogens are one of the most relevant problems in Neonatal Intensive Care Unit (NICU). Many factors contribute to the onset of an epidemic, including virulence of the pathogen and vulnerability of the infants hospitalized in NICU. Outbreaks are often caused by multidrug-resistant organisms (MDROs). MDROs are defined as microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. MDROs, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and certain gram-negative bacilli (GNB), have important infection control implications. Once MDROs are introduced into a healthcare setting, transmission and persistence of the resistant strain is determined by the availability of vulnerable patients, selective pressure exerted by antimicrobial use, increased potential for transmission from larger numbers of infected or colonized patients ("colonization pressure"), and the impact of adherence to prevention efforts. Often, routine infection control measures are not enough to contain outbreaks, and additional control measures are needed, including implementation of hand hygiene, cohorting of infected/colonized infants, neonatal surveillance cultures, screening of healthcare workers and decolonization of neonates and/or healthcare workers in selected cases. In this review, we report the practices we developed in our NICU to contain an epidemic. These recommendations reflect the experience of the group, as well as the findings of the current literature.