Infections in the perinatal period are creating more concern for healthcare providers. Certain conditions have increased the risk for infection in this decade. Some contributing factors are migratory influx from other countries, noncompliance with vaccination programs, and antibiotic resistance. These factors, although not inclusive, provide the background for the focus of the three perinatal articles in this issue on Infections.

The article by Terri Rebmann addresses the potential risk of avian influenza (HSN1). This infection is emerging in other countries at alarming rates. Rebmann gives an in-depth overview of the epidemiology and clinical presentation of this infection. She approaches the assessment and management from a pandemic viewpoint. Epidemiological strategies are presented to assist hospitals and communities in avian influenza identification and disaster preparedness if an outbreak occurs. This article suggests effective approaches that perinatal and neonatal nurses can develop should this emergent situation arise.

Aquilina and Winkelman examine the impact of tuberculosis on women who decide to breast-feed. However, the question of safety and breast-feeding in women with active tuberculosis is explored. They critique the pros/cons of the breast-feeding issue in this population as well as nursing implications for monitoring, provision of care, and educational counseling for mothers affected with this disease. Information is provided for healthcare professionals on wet nurses and the risk of tuberculosis transmission to newborns. This area is controversial but important in contemporary society. Finally, Aquilina and Winkelman summarize their recommendations based on current literature to provide a safe breast-feeding situation for families with active tuberculosis.

Kriebs outlines the importance of prevention and selective prenatal testing for certain infections. The article emphasizes the need for updating vaccination schedules for adults. Some of the infectious diseases that are highlighted in this article are HIV, pertussis, and influenza. Kriebs suggests further that vaccination and treatment, although available, are still not eliminating the risk of infectious disease. The emergence of methacillin-resistant Staphylococcus aureus has created an environment that makes treatment uncertain. It is important that maternal-child healthcare providers take into account all these factors when screening patients for infection. It is also crucial that healthcare providers maintain updated knowledge on infection control, which initially starts with good hand-washing practices.

Infection is a significant cause of morbidity and mortality in the newborn infant. The functional immaturity of the neonatal immune system due to factors such as reduced phagocytic activity and impaired immunoglobin synthesis puts all newborns at risk for sepsis. For premature newborns, the risk is even higher because they are born before placental transfer of protective maternal antibodies. Extremely low-birth-weight infants are 5 to 10 times more likely to develop infection than even full-term newborns.1

Infection acquired during the perinatal period occurs in about 8% of newborns.2 The most common organism for early-onset sepsis is group B streptococcus (GBS). Nandyal provides an update on GBS sepsis in the newborn, giving a historical perspective of preventive approaches and treatments of GBS sepsis. He further discusses current national guidelines and treatment strategies, diagnostic approaches currently in use for infection, and recommendations for early identification of sepsis in the newborn.

Infants hospitalized in the neonatal intensive care unit (NICU) for extended periods are at risk for hospital-acquired or nosocomial infections. They become colonized with organisms that can cause infection, and many NICUs develop strains of organisms that are difficult to eradicate. Antibiotic use and increased drug resistance to antimicrobial therapy contribute to the problem, as do invasive lines, poor skin integrity, and immature immune function. Newby gives a comprehensive summary of nosocomial infections in the NICU. Her continuing education article focuses on transmission, identification, and strategies to minimize the risk of infection occurrence in the NICU and recommendations for nursing care are provided.

An intriguing new treatment on the horizon is discussed by Shane in her paper on probiotics. These microbes that can potentially modulate the host defense response and improve gut barrier function are still under study for uses in infants.3 This review article focuses on the development and applications of probiotics for the intestinal tract and applications for conditions as necrotizing entercolitis. Research in the area of probiotics is ongoing and the potential is exciting. This issue of JPNN discusses assessing, diagnosing, and treating infection in infants. Infection risk to infants is significant. Continued research is needed to develop improved measures for infection prevention, earlier identification, and new therapies.

Marsha A. Marecki, EdD, CNS, WHNP-C

Perinatal Guest Editor

Maryann Bozzette, PhD, RN

Neonatal Guest Editor

REFERENCES