Why are preterm newborns at increased risk of infection?

Collins, Amélie; Weitkamp, Jörn-Hendrik; Wynn, James L.

doi:10.1136/archdischild-2017-313595

Cited by 177 publications

(144 citation statements)

References 43 publications

(40 reference statements)

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…20,21,[34][35][36][37][38][39][40][41][42][43] Lower gestational age is associated with less effective opsonic, neutrophilmediated defenses in the infant as well as lower levels of protective maternally derived antibody. [44][45][46] Increased duration of rupture of membranes (ROM) promotes the process of ascending colonization and infection of the uterine compartment and fetus. Maternal intrapartum fever may reflect the maternal inflammatory response to evolving intraamniotic bacterial infection and is an important predictor of neonatal early-onset infection.…”

Section: Pathogenesis Of and Risk Factors For Gbs Infection Eodmentioning

confidence: 99%

Management of Infants at Risk for Group B Streptococcal Disease

et al. 2019

View full text Add to dashboard Cite

Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants. Administration of intrapartum antibiotic prophylaxis is the only currently available effective strategy for the prevention of perinatal GBS earlyonset disease, and there is no effective approach for the prevention of late-onset disease. The American Academy of Pediatrics joins with the American College of Obstetricians and Gynecologists to reaffirm the use of universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of intrapartum antibiotic prophylaxis. The purpose of this clinical report is to provide neonatal clinicians with updated information regarding the epidemiology of GBS disease as well current recommendations for the evaluation of newborn infants at risk for GBS disease and for treatment of those with confirmed GBS infection. This clinical report is endorsed by the American College of Obstetricians and Gynecologists (ACOG), July 2019, and should be construed as ACOG clinical guidance. The Centers for Disease Control and Prevention (CDC) first published consensus guidelines on the prevention of perinatal group B streptococcal (GBS) disease in 1996. These guidelines were developed in collaboration with the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives, the American Academy of Family Physicians, and other stakeholder organizations 1 on the basis of available evidence as well as expert opinion. The 1996 consensus guidelines recommended either an antenatal culture-based or risk factor-based approach for the administration of intrapartum antibiotic prophylaxis (IAP) to prevent invasive neonatal GBS early-onset disease (EOD). 1 The guidelines were updated in 2002 primarily on the basis of new data from a CDC multistate retrospective cohort study in which authors found universal screening for group B streptococci (Streptococcus agalactiae) was .50% more effective at preventing the disease compared to a risk-based approach. 2,3 In 2010,

show abstract

Section: Pathogenesis Of and Risk Factors For Gbs Infection Eodmentioning

confidence: 99%

Management of Infants at Risk for Group B Streptococcal Disease

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In strong support of this view, infections and sepsis in both ends of the age spectrum are usually more severe, more frequent, and exhibit higher morbidity and mortality, even when appropriate antimicrobials are used in the correct indication, dosing and timing, possibly reflecting the fact that the immune system is dysfunctional in elders and immature in the young (8,(95)(96)(97). A complex pattern of susceptibility to infections associated to pathogen multiplicity and diversity also occurs in secondary and primary severe immune deficiencies, leading to higher morbidity and mortality.…”

Section: Discussionmentioning

confidence: 97%

Immune Response Resetting in Ongoing Sepsis

Nowill

Fornazin

Spago

et al. 2019

The Journal of Immunology

View full text Add to dashboard Cite

Cure of severe infections, sepsis, and septic shock with antimicrobial drugs is a challenge because morbidity and mortality in these conditions are essentially caused by improper immune response. We have tested the hypothesis that repeated reactivation of established memory to pathogens may reset unfavorable immune responses. We have chosen for this purpose a highly stringent mouse model of polymicrobial sepsis by cecum ligation and puncture. Five weeks after priming with a diverse Ag pool, high-grade sepsis was induced in C57BL/6j mice that was lethal in 24 h if left untreated. Antimicrobial drug (imipenem) alone rescued 9.7% of the animals from death, but >5-fold higher cure rate could be achieved by combining imipenem and two rechallenges with the Ag pool (p < 0.0001). Antigenic stimulation fine-tuned the immune response in sepsis by contracting the total CD3 + T cell compartment in the spleen and disengaging the hyperactivation state in the memory T subsets, most notably CD8 + T cells, while preserving the recovery of naive subsets. Quantitative proteomics/lipidomics analyses revealed that the combined treatment reverted the molecular signature of sepsis for cytokine storm, and deregulated inflammatory reaction and proapoptotic environment, as well as the lysophosphatidylcholine/phosphatidylcholine ratio. Our results showed the feasibility of resetting uncontrolled hyperinflammatory reactions into ordered hypoinflammatory responses by memory reactivation, thereby reducing morbidity and mortality in antibiotic-treated sepsis. This beneficial effect was not dependent on the generation of a pathogen-driven immune response itself but rather on the reactivation of memory to a diverse Ag pool that modulates the ongoing response.

show abstract

“…Exclusive HM feeding is of utmost importance for preterm infants, as MOM-feeding is linked to a reduction in the incidence of life-threatening diseases, such as NEC and LOS, as well as to an improvement in preterm infants' neurodevelopment [69]. HM feeding promotes a healthy microbiome, supports appropriate maturation of the developing immune system [70], and protects infants against infections mainly via secretory IgA antibodies, as well as via immunomodulatory factors such as enzymes (lysozyme, lactoferrin, etc. ), cytokines, complement system components, leukocytes, oligosaccharides, nucleotides, lipids, and hormones, which ensure host defence against infections and modulate the immune response [3].…”

Section: Human Milk Microbiota: Implications For Preterm Infants' Carmentioning

confidence: 99%

Human Milk’s Hidden Gift: Implications of the Milk Microbiome for Preterm Infants’ Health

et al. 2019

View full text Add to dashboard Cite

Breastfeeding is considered the gold standard for infants’ nutrition, as mother’s own milk (MOM) provides nutritional and bioactive factors functional to optimal development. Early life microbiome is one of the main contributors to short and long-term infant health status, with the gut microbiota (GM) being the most studied ecosystem. Some human milk (HM) bioactive factors, such as HM prebiotic carbohydrates that select for beneficial bacteria, and the specific human milk microbiota (HMM) are emerging as early mediators in the relationship between the development of GM in early life and clinical outcomes. The beneficial role of HM becomes even more crucial for preterm infants, who are exposed to significant risks of severe infection in early life as well as to adverse short and long-term outcomes. When MOM is unavailable or insufficient, donor human milk (DHM) constitutes the optimal nutritional choice. However, little is known about the specific effect of DHM on preterm GM and its potential functional implication on HMM. The purpose of this narrative review is to summarize recent findings on HMM origin and composition and discuss the role of HMM on infant health and development, with a specific focus on preterm infants.

show abstract

Why are preterm newborns at increased risk of infection?

Cited by 177 publications

References 43 publications

Management of Infants at Risk for Group B Streptococcal Disease

Management of Infants at Risk for Group B Streptococcal Disease

Immune Response Resetting in Ongoing Sepsis

Human Milk’s Hidden Gift: Implications of the Milk Microbiome for Preterm Infants’ Health

Contact Info

Product

Resources

About