Endotracheal intubation is a common procedure in newborn care. The purpose of this clinical report is to review currently available evidence on use of premedication for intubation, identify gaps in knowledge, and provide guidance for making decisions about the use of premedication.

Health care-associated infections in the NICU result in increased morbidity and mortality, prolonged lengths of stay, and increased medical costs. Neonates are at high risk of acquiring health care-associated infections because of impaired host-defense mechanisms, limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth, reduced barrier function of their skin, use of invasive procedures and devices, and frequent exposure to broad-spectrum antibiotic agents. This clinical report reviews management and prevention of health care-associated infections in newborn infants.

Health care−associated infections in the NICU are a major clinical problem resulting in increased morbidity and mortality, prolonged length of hospital stays, and increased medical costs. Neonates are at high risk for health care−associated infections because of impaired host defense mechanisms, limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth, reduced barrier function of neonatal skin, the use of invasive procedures and devices, and frequent exposure to broad-spectrum antibiotics. This statement will review the epidemiology and diagnosis of health care−associated infections in newborn infants. Pediatrics 2012;129:e1104-e1109 INTRODUCTIONHealth care−associated infections are infections acquired in the hospital while receiving treatment of other conditions. They are common occurrences in patients of all ages and are estimated to result in 2 million infections, 90 000 deaths, and $28 to $45 billion in excess health care costs annually. 1,2 In the Pediatric Prevention Network national point prevalence survey, 11.2% of NICU patients had a health care−associated infection on the day of the survey. 3 Although there are no recent estimates of the cost of health care−associated infections in the NICU, Payne et al 4 estimated that health care-associated bloodstream infections added almost $100 million to the cost of treating infants with birth weights from 500 to 1499 g in 1999 dollars. Because this finding represented the excess costs associated with only one type of infection in one gestational age cohort, it provides just a glimpse of the financial impact of health care−associated infections in the NICU. This financial estimate does not include the potential morbidity and mortality concerns for the infant and the effect that the prolonged hospital stay has on the family and resource utilization within the hospital. Reducing health care−associated infections in the NICU would have benefits to infants, families, and the health care delivery system. The purpose of this technical report was to review the epidemiology and diagnosis of health care-associated infections in the NICU. A companion policy statement addresses strategies for the prevention of health care-associated infections. EPIDEMIOLOGYNewborn infants hospitalized in a NICU have host factors that not only make them more vulnerable to acquisition of health care-associated infections but also increase their risk of developing more serious illnesses. Whether an infant is born preterm or at term, many components of their innate and adaptive immune systems exhibit diminished function when compared with older children and adults. Infants with birth weights less than1500 g (very low birth weight) have rates of health care-associated infections 3 times higher than those who weigh greater than 1500 g at birth. However, the increased susceptibility to infection in infants of very low birth weight is multifactorial and related to both the developmental deficiencies in the innate and adaptive immune systems and a greate...

High-risk (HR) and low-risk (LR) preterm infants (N = 212) and full-term infants (FT, N = 128) from low socio-economic homes were studied with their mothers in the home at 6 and 12 months of age. Infants' cognitive, language and daily living skills were evaluated in relation to mothers' warm sensitivity, use of strategies which maintained the infants' attention and directiveness. Higher levels of maternal attention-maintaining were positively related to infant development for all groups. During toy play, attention-maintaining was most strongly related to expressive language skills for the HR infants; during toy play and daily activities, this maternal behavior was more strongly related to cognitive and language skills for both preterm groups than for the FT infants.

Using Hierarchical Linear Models (HLM) analysis, this study evaluated the effects of medical risk at birth and socioeconomic status (SES) on the rate of change in cognitive and social development over the first three years of life in premature children with low birth weight (LBW). Children with LBW (n = 79) with both high (HR) (n = 37) and low (LR) (n = 42) medical risk were compared to healthy full-term (FT) (n = 49) children. Children were assessed longitudinally at 6, 12, 24, and 36 months for cognitive development with the Bayley Scales of Infant Development and the McCarthy Scales for Children's Abilities, and for social initiative and responsiveness with observational measures. The HR LBW group had slower rates of increases in cognitive scores than did the LR LBW and FT groups and showed more deceleration in cognitive development by 36 months of age. Children with LBW, regardless of medical risk, had lower social initiating scores and slower rates of increase in initiating across the first 36 months than did FT children. As predicted, the groups did not show different rates of change for measures of social responsiveness. Higher SES was predictive of better cognitive and social development for all children. The difficulties encountered by children with LR and HR LBW in developing social initiating skills are discussed in relation to the link between learning to take initiative and early executive function skills.