Richard Polin, MD

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:       "Hi, I’d like to introduce Dr. Richard Polin who will be speaking       to us from Salzburg on how to prevent infection in the newborn - Dr. Polin."

:       "Yes, I’m a Professor of Pediatrics at the College of Physicians of       Columbia University and Director of Neonatology at Columbia Presbyterian       Medical Center and at Babies and Children’s Hospital in New York.

The question that I’ve been asked is       how to prevent infections in the newborn. The most effective strategy is       one, which has already been initiated by ACOG, AP, and CDC and that is the       intrapartum use of antibiotics either for colonized women during labor and       delivery or for women who have risk factors for infection. Unfortunately,       that strategy is not completely effective in about 20%-25% of babies in       whom the mothers receive intrapartum therapy still are born with early       onset streptococcal sepsis. Therefore, recent attention has been directed       towards other strategies or interventions, which might further decrease       the risk of infection or lower the immortality-morbidity of infection. One       such strategy which is yet untested but for which there’s a great       theoretical and scientific argument, is the use of post-natal penicillin       prophylaxis for asymptomatic infants born to either women whose       colonization status is unknown or to women who receive inadequate       treatment such as only an hour or two before delivery. A study completed       in 1980, published by Segal MacCracken in the New England Journal of       Medicine, suggested that 50,000 units of aqueous penicillin IN was an       effective strategy to prevent early onset streptococcal sepsis. The       estimates are that the use of intrapartum therapy plus selective use of       post-natal penicillin prophylaxis might be effective in up to 90% of       cases; however, a prospective trial has not been performed as yet.

The other strategies, which have been       suggested as a way to prevent infection, include the use of intravenous       immunoglobulin. IVIG contains antibodies that babies who are born       prematurely may lack because there has not been enough time for transfer       of antibodies from the maternal to the baby’s circulation. There have       been approximately eighteen studies, which have looked at the prophylactic       use of intravenous immunoglobulin to prevent nosocomial sepsis in newborn       babies. If one performs a meta-analysis, it looks as if IVIG is an       effective strategy but the two best studies to date - one performed by the       NICHD on 2,400 babies and one performed by Carol Baker in Houston with       about 600 babies, have yielded conflicting results. The NICHD study did       not demonstrate an effectiveness of IVIG to prevent nosocomial sepsis       where as the study by Carol Baker did. The studies were very different;       they used different kinds of intravenous immunoglobulin at different doses       and for different numbers of doses.

The feeling at this time is that IVIG       might be an effective strategy if the preparation you’re using to give       to a high-risk premature infant contains the right pattern of antibodies.       Unfortunately, when you pull a vial off the shelf there’s no assurance       it contains the antibodies against the kinds of pathogens which infect       newborn babies which include streptococcus epidermitis,

gram negatives, and that’s the reason probably for some of the       discrepancy in the studies. The last possible intervention for decreasing       nosocomial sepsis is to identify high-risk care practices, which are       associated with an increased risk of nosocomial infection. The practices       which have been identified thus far include the use of any indwelling       catheter be it umbilical arterial or umbilical venous catheter, peripheral       intravenous catheters, the use of post-natal steroids - not antenatal       steroids, the use of H2 blockers, and the degree of illness obviously       correlates with the U.S.

nosocomial infection.       Therefore, as neonatologists we have to look at those care practices or       risk factors and try to avoid them when we take care of sick newborn       infants or at least use those interventions such as umbilical catheters       for the shortest period of time."

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OBGYN.net Conference CoverageFrom American/Austrian Conference, Salzburg Austria March 4-10, 2000

Author | Richard Polin, MD

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