Nosocomial infections in very preterm neonates -- improvements by further scientific research or discussions in talk shows?

tis. This also has recently been proven for the administration of lactoferrin [ 13 ] and probiotics [ 8 ] . The adoption of a standardized nutritional regimen in very preterm neonates has further been shown to reduce above-mentioned complications [ 16 ] . Additionally, a decline of nosocomial infections was achieved through the implementation of programs for quality improvement through improved catheter care [ 11 ] . Moreover, national programs for quality control in neonatal care with respect to nosocomial infections (NEO-KISS program, Germany) [ 12 ] were also able to impact on the reduction of the severity of infections. It is also known from registers in other settings that outcomes can be improved [ 18 ] . Registers, when using similar criteria, enable the scientifi c community to compare mortality and morbidity rates of e. g. nosocomial sepsis in very low birth weight neonates, who were cared for in diff erent geographical regions: For example, the reported rates of nosocomial infections from a large German national network (German Neonatal Network, GNN) were recently reported to be between 9 and 10 % and compared with the data from the Vermont-Oxford Network mainly enrolling neonates from North America, which was reported to be between 17 and 18 %. Defi nitions of nosocomial infections and enrollment criteria, i. e., birth weight categories, were identical in both registers. However, how do those improvements in the better understanding of the pathophysiology of nosocomial infections and the related progress in the fi eld of neonatology translate into the German public perception in print and electronic media? During the past decade, a number of series of nosocomial infections attracted a considerable public interest in Germany. Public awareness has increased considerably during the last 3 years in particularly through the clusters of infections in various neonatal intensive care units in Berlin, Charité [ 2 ] , Bremen [ 3 ] and in Mainz [ 1 ] . The leitmotif of all discussions in the public on nosocomial infections appears to be poor hygiene and public opinion seems to indicate that high numbers of infections could be prevented by improving hygienic measures, thereby ignoring the high risk state of very preterm neonates and the above outlined complex pathophysiology [ 4 ] . Through the press, it further has been suggested that several thousands of deaths could be readily prevented by improving basic hygienic measures in neonatal intensive care units [ 4 ] . Nosocomial sepsis in very preterm neonates (gestational age < 32 weeks) has considerable implications in terms of acute mortality or lifethreatening morbidity and the risk of long-term sequelae [ 5 , 11 , 19 , 20 ] . During the past decade, nosocomial gram-negative translocation sepsis and necrotizing enterocolitis have been researched extensively with the aim to identify molecular, immunologic and clinical risk factors [ 17 ] . Molecular factors, such as polymorphisms in genes controlling local immunity and cell-tocell-communication [ 17 ] , immunologic risk factors including quantitative and qualitative specifi cs in complement components and innate immunity [ 10 ] as well as phagocytic activity and immunoglobulines [ 5 ] among others, have been identifi ed as contributing factors in the development of the nosocomial sepsis. New and highly specifi c and sensitive diagnostic tools have been developed in order to identify neonates with sepsis early on [ 12 ] . Furthermore, in large clinical trials additional risk factors have been identifi ed, those include, among others, vascular access for providing parenteral nutrition as well as babies who were born with a low birth weight following impaired intrauterine growth (IUGR – Intrauterine Growth Restriction) [ 7 , 15 ] . Even the colonization with causative agents of nosocomial sepsis has been proven to be associated with the degree of neonatal immaturity and birth weight [ 14 ] . One major step in understanding the pathophysiology of nosocomial sepsis and necrotizing enterocolitis was the fi nding that microbial translocation from the neonatal intestine could explain a major part of the pathogenesis of necrotizing enterocolitis as well as nosocomial gram-negative translocation sepsis [ 17 ] . It has been shown that the immaturity of the local immune system within the intestine, cell-to-cellcommunication and cell-mediated immunity are key players in the high susceptibility of very preterm neonates for developing gram negative sepsis [ 10 , 17 ] . On the basis of our improved knowledge, a number of immunologic interventions were investigated in carefully controlled clinical trials, such as the administration of hematologic growth factors (GM-CSF and G-CSF) and intravenous and oral immunoglobulines, among others. So far, none of these concepts proved to be eff ective in reducing neither necrotizing enterocolitis nor nosocomial sepsis [ 5 , 6 , 9 ] . However, it had been clear for more than 2 decades that breast milk may reduce the frequency of nosocomial sepsis and necrotizing enterocoliBibliography DOI http://dx.doi.org/ 10.1055/s-0033-1334959 Klin Padiatr 2013; 225: 55–56 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0300-8630