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Infections In A Premature Baby

Team AckoFeb 8, 2024

All newborn babies are at risk of infection because their immune systems are not yet mature and this is especially true for premature babies. Having a premature baby in the NICU is a difficult and challenging situation for any parent. Approximately, one out of every 10 babies are born prematurely each year, keeping the NICUs around the country very busy.



A premature baby can develop infections in almost any part of the body; the most common sites involve the blood, the lungs, the lining of the brain and spinal cord, the skin, the kidneys, the bladder, and the intestines. Infection may also be acquired during birth from the natural bacteria that live in the genital tract, as well as other harmful bacteria and viruses.

Why do premature babies get infections so easily?

Premature babies are subject to a host of threats that can result in fetal/neonatal disease. Babies have an inexperienced immune system. They have not had time to build up their own antibodies to fight infection. Preemie babies get fewer antibodies from their mothers since most antibodies go across the placenta to the baby in the last few months of pregnancy.

Preemie babies often have intravenous catheters. These may serve as routes of entry for bacteria. They also don’t have enough ͞good͟ bacteria on them to provide protection, and their skin is very fragile. They often have breathing tubes and central lines, creating ways for bacteria to enter their bodies. Furthermore, the broad-spectrum antibiotics these fragile babies are often given put them at even more risk for a serious infection.

Preemie babies frequently are given antibiotics for infections. These kill the bacteria most likely to cause infection, but enable other less common germs to grow more easily.

Possible signs of infection

If your newborn baby shows any of these possible signs of infection then call your child care expert or get emergency medical care:

 She's floppy, restless, or irritable and doesn't seem 'right'

 Has poor feeding

 Has a temperature below 36°C or over 37.8°C for more than one hour

 Has rapid breathing

 Has a heart rate of more than 160 beats per minute

 Has vomiting or diarrhea

 Has spots, rash or jaundice

 Is weeping, oozing or a foul smell from an affected area

 Has a lack of alertness or activity

 Has difficulty tolerating feedings

 Has an inability to maintain her body temperature

 Has pale or spotted skin color, or a yellowish tint to the skin (jaundice)

These signs may be mild or dramatic, depending on the severity of the infection.


Premature babies are often anemic. This means that they do not have enough red blood cells. Normally, the fetus stores iron during the latter months of pregnancy and uses it after birth to make red blood cells. Loss of blood from frequent blood tests also can contribute to anemia. Anemic infants may be treated with dietary iron supplements, drugs that increase red blood cell production or, in some cases, a blood transfusion.

Breathing problems:

Premature babies often have breathing problems because their lungs are not fully developed. An infant with breathing problems may be given medicines, a mechanical ventilator to help him breathe, or a combination of these two treatments.


Apnea is when a baby stops breathing for more than 15 seconds. Apnea may be accompanied by a slow heart rate called bradycardia. Babies in the NICU are constantly monitored for apnea and bradycardia (often called "A's and B's͟).

Sensors on the baby's chest send information about his breathing and heart rate to a machine located near the incubator. If a baby stops breathing, an alarm will begin beeping. A nurse will stimulate the baby to start breathing by patting him or touching the soles of his feet. The neonatologist might consider giving the baby medicine or using equipment, such as C-PAP (continuous positive airway pressure; delivery of air to a baby's lungs through either small tubes in the baby's nose or through a tube inserted into the windpipe).

Bronchopulmonary dysplasia (BPD):

This chronic lung disease is most common in premature babies who have been treated for respiratory distress syndrome (RDS). Babies with RDS have immature lungs. They sometimes need a mechanical ventilator to help them breathe. Some babies treated for RDS may develop symptoms of BPD, including fluid in the lungs, scarring and lung damage.

Babies with BPD are treated with medications to help make breathing easier. They are slowly weaned from the mechanical ventilator.

Persistent pulmonary hypertension of the newborn (PPHN):

Babies with PPHN cannot breathe properly because of the high blood pressure in their lungs. Babies with PPHN often have birth defects (such as heart defects) or have suffered from birth complications. Babies with PPHN often need a mechanical ventilator to help them breathe. They may be given a gas called nitric oxide through a tube in the windpipe. This treatment may help the blood vessels in the lungs to relax and improve breathing.


This lung infection is common in premature and other sick newborns. If the baby has difficulty breathing then it can be a case of Pneumonia. If her rate of breathing changes, or if the baby has an increased number of apnea episodes. The doctor will listen to the baby's lungs with a stethoscope and then do an X-ray to see if there is excess fluid in the lungs. Sometimes the doctor may insert a tube into the lungs to take a sample of the lung fluid. The fluid is then tested to see what type of bacterium or virus is causing the infection, so that the doctor can choose the most effective drug to treat it.

Babies with pneumonia are generally treated with antibiotics. They also may need additional oxygen until the infection clears up.

Respiratory distress syndrome (RDS):

Babies born before 34 weeks of pregnancy often develop this serious breathing problem. Babies with RDS do not have enough surfactant, which keeps the small air sacs in the lungs from collapsing. Babies with RDS also may receive a treatment called C-PAP (continuous positive airway pressure). The air may be delivered through small tubes in the baby's nose, or through a tube that has been inserted into his windpipe.

The sickest babies may temporarily need th;e help of a mechanical ventilator to breathe for them while their lungs recover.

Treating infections in premature babies

If your baby has an infection, the treatment will depend on what sort of infection she has. Bacterial infections are treated with antibiotics, while fungal infections are treated with anti-fungal medications. Viral infections may be treated with supportive measures such as good nutrition, although there are specific treatments for some viruses. If your baby has a contagious infection, such as a respiratory virus, she may be nursed in an isolated setting.

Will there be permanent problems from infection?

Most of the time the baby's infection responds rapidly to antibiotics. Usually there are no permanent problems from infection. Permanent problems are most likely if the baby has meningitis, or if there has been severe low blood pressure for a long period of time.

Disclaimer: This content is for informational purposes only, based on industry experience and secondary sources. It is not a substitute for professional advice. Please consult a qualified expert for health or insurance-related decisions. Content is subject to change, refer to current policy wordings for specific ACKO details.



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