Immune modification to prevent nosocomial sepsis in hospitalized newborns

Preterm infants receiving intensive care have high rates of nosocomial infections. Developmental facets of host defense, medical interventions, and the hospital environment contribute to septicemia rates exceeding 40% in extremely low-birthweight infants. Septicemia is an important cause of morbidity and mortality in these fragile infants. This review focuses on the neonate's relative deficiencies of innate and humoral immunity and describes strategies to modify the immune response to prevent nosocomial infection. Human milk feeding is an effective immune modifier and decreases infection rates in hospitalized preterm infants. Results of studies of pharmacologic agents such as polyclonal intravenous immune globulin and colony-stimulating factors to reduce nosocomial infections have been mixed. Specifically targeted immunotherapy with monoclonal antibodies and probiotics are being investigated and may become effective tools to reduce nosocomial infections in the future.