What Are We Missing in Neonatal Infection Research?
SEP 03, 2016 | CONTAGION EDITORIAL STAFF
Craig Rubens, MD, PhD, co-founder and executive director of GAPPS at Seattle Children’s Hospital, discusses the need for more research on neonatal infections.
Interview Transcript (slightly modified for readability)
“We need more research on neonatal infections: how they occur, how much they occur, why they occur, and then what [we can] do to improve treatment. Right now, we have some estimates of what types of infections [and] what kind of bugs and bacteria are causing these infections, [but] we have no idea what the importance of viral infections are. Because of this, [ pediatricians and other healthcare providers in these settings] end up using very loose clinical criteria, especially in the first 30 days of life, to really determine whether a baby has a serious infection or not.
Because we don’t want to lose them, we end up going ahead and doing complex diagnostics and starting antibiotic therapy on these babies because we want to get ahead of the infection, if possible. The outcome of that is that 90% of the time we’re probably over-treating these babies. This occurs even in the developed world, even in the United States, because we don’t have good diagnostics to tell us whether a baby has a serious bacterial infection, or a viral infection that just requires some support but not antimicrobial therapy.
Because we’re using lots of antibiotics in these settings, and sometimes inappropriately, we are having a problem now with antibiotic resistance occurring from bacterial agents that are actually coming from moms and babies from around the globe. We have an important research agenda that really needs to be brought forward and invested in. [We need to understand] the numbers of these infections that occur, how they [are transmitted] between mothers and infants, and then how, in these complex low-resource settings, most of these babies are home not in a hospital, could we do a better job of reaching them early: recognizing those that have these serious bacterial infections, and then getting treatment to them in an appropriate time frame.”
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Big advances in treatment can't make up for an inability to stop new infections, which number 5,000 per day worldwide.
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