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Preemies are at Greater Risk for Infection in the NICU

Having a premature baby in the NICU is a difficult situation for any parent — and it’s unfortunately common. Approximately one out of every 10 babies are born prematurely each year, keeping the NICUs around the country very busy.

While it’s natural to spend most of your time worrying about the original reason your baby is in the NICU, many parents don’t realize that infections are a serious complication that affects many NICU babies. Their immature immune systems are unable to adequately protect them from germs. They also don’t have enough “good” 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.

Infections outbreaks in a NICU are rare, but they can be devastating. Called “nosocomial infections,” these infections are acquired within the hospital. They can be due to bacteria, virus, or fungus. The most common nosocomial infections are pneumonia, bloodstream infections, urinary tract infections, and surgical site infections.

In the medical literature, there are numerous reports of outbreaks of nosocomial infections in NICUs with devastating results. In 2016, a NICU in Maryland found that its water system was contaminated with Pseudomonas aeruginosa, a bacteria commonly found in soil and water but known to cause deadly infections in NICU babies. While Pseudomonas may be harmless to a child or adult with a healthy immune system, it can be catastrophic to premature babies. This outbreak ultimately caused the NICU to close for months in an attempt to control the deadly infection. Other studies have shown contaminated sink drains, bottle warmers, and laboratory equipment.

Studies suggest that poor hand-washing contributes to the spread of infections. Patients who have central lines are especially at risk, as the hub of the line can become contaminated with bacteria. Artificial fingernails have also been identified as a risk factor, as germs get trapped under the nails. Some NICUs are overcrowded and understaffed, putting a strain on resources and ultimately contributing to the spread of infection.

Hospitals take nosocomial infections very seriously. Not only do these infections cause more infant deaths, but they also drive up healthcare costs significantly.

National measures have been put into place to keep track of infections in hospitalized patients and track which hospitals are above the national average for certain types of infections. In the NICUs, doctors, nurses, and other healthcare providers have been educated extensively about the importance of hand hygiene playing a vital role in preventing the spread of infections. With 25-50% of premature babies suffering from nosocomial infections, it will take a team effort to reduce the incidence of these devastating infections.


  • Centers for Disease Control and Prevention
  • Preterm Birth.
    Journal of Medical Microbiology
  • aeruginosa outbreaks in the NICU.
    Nosocomial Infections in the Neonatal Intensive Care Unit.
    Epidemiology and Diagnosis of Health Care-Associated Infections in the NICU.
    World Health Organization
  • Preterm Birth.

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