GUEST EDITORIAL

From the Creighton Universit© 2010 Elsevier Inc. All righ1527-3369/1004-0375$36.00doi:10.1053/j.nainr.2010.09.0

Guest Editorial: Neonatal Infection

Lori Baas Rubarth, PhD, APRN, NNP-BC

How many times have you come across an infant inyour unit who just “didn't look right”? As neonatalintensive care unit (NICU) nurses, we spend many

days caring for the tiny, premature infant with respiratorydistress who develops sepsis. These small, premature infantshave a deficient immune system and are at-risk for sepsisduring their stay in the NICU. Also, many term or near-terminfants are admitted daily to the NICUs around the countrywith a diagnosis of rule-out sepsis. We take care of them,start their intravenous regimens, give them antibiotics, andreassure their parents. Most of these term infants improveand go home within a short period of time. But some ofthese infants die of overwhelming sepsis. The care of theseinfants can be frustrating to the nurse, when dealing with themultiple problems that sepsis can cause. All infants in theNICU must be continually assessed for sepsis throughouttheir often lengthy stays. The nurse is at the bedside andmust be able to pick up on the sometimes subtle signs ofsepsis. The earlier the nurse realizes that the baby's conditionhas changed, the earlier the treatment of sepsis can start, andthe better the baby's chances of survival. This month'sjournal is devoted to neonatal sepsis, and we have some greatarticles on this topic.

In the first article of our series, Newnam and McGrathdiscuss the infant's deficient immune system, the inflammatoryresponse, and the links to later neurodevelopmental outcomes.In the second article on sepsis, meningitis, and pneumonia, Iattempt to differentiate the many types of infections that canoccur in the infant, as well as provide an explanation of thevarious definitions used with infections in the neonate. Systemicinflammatory response syndrome and multiple organ dysfunc-

y School of Nursing, Omaha, NE.ts reserved./002

tion syndrome are introduced and discussed with a symbolicrepresentation of sepsis in the newborn.

The next two articles provide information on late-onsetinfections, including group B Streptococcus. Chuffo-Siewertand Holida give us some clinical scenarios, and they review thecases that have actually occurred in the NICU with a review ofthe infants' outcomes. These cases include both early-onset andlate-onset infections with a nice overview of the differencesbetween the same bacteria affecting infants at different timesand with different presentations. Then, Anderson reviews thehospital-acquired infections seen in the NICU environment anddiscusses prevention strategies.

The fifth article in this series deals with viral infections thatcan affect the neonate either on admission or during their NICUstay. O'Keefe presents a thorough overview of cytomegalovirus,herpes simplex virus, and HIV, including signs and manage-ment strategies. In the sixth article, Carlson provides anoverview of the pharmacokinetics and pharmacodynamics withan application of these principles to the use of antibiotics in theinfant with sepsis. The importance of drug levels is stressed. Inthe final article, Tappero and Johnson conclude by providinginformation on the laboratory tests used in diagnosing sepsis,including blood cultures, C-reactive protein, and some newerdiagnostic markers for neonatal sepsis.

Overall, this series of articles will provide you with a betterunderstanding of the process of sepsis, its development in thenewborn infant, the signs of infection, and the treatmentstrategies that should be implemented. Your observations canlead to early diagnosis and treatment of these infants. You are inthe position to save a life by observant care and quick responseto variations in your infant's condition.