Infection
Updated: 5/19/10 & 7/21/2013
KC infants have fewer/less severe infections
Anderson et al., 2003
AWHONN, 2008?
Canadian Paed Society 2012
Charpak et al., 1997
Charpak et al., 2001
Clarke, 2009
Conde-Agudelo et al., 2000b
Conde-Agudelo et al., 2003
Conde-Agudelo et al.,2007
Conde-Agudelo et al. 2011
Crenshaw et al., 2004
Darmstadt et al., 2000
Mendes & Procianoy, 2008,09
Gangal, 2007
Gottesman,2009
Gupta et al., 2007
Hall & Kirsten, 2008
Hardy, 2011
Hendricks-Munoz, 2002
Heyns et al., 2006
Institute of Medicine 2007
Jeanette et al. 2004
Jefferies et al. 2013
Kambarami 2002
Meta-Analysis showed KC associated with fewer nosocomial infections
Positive benefits of KC include decreased incidence and severity of
Infection., pg. 243.
PT, Position statement that reviews the fact that KC reduces
nosocomial infection and then talks about infants being colonized to
mother, no spreading of infection from one pair to another, and KC can
continue during infectious outbreaks.
PT, RCT, # & proportion of infectious episodes that had to be treated
during hospitalization was same, proportion of nosocomial infections
after eligibility and before discharge was less in KMC (3.8%) than
controls (7.8%, p=0.026)(pg. 685). Number of total infectious episodes
that had to be treated in hospital was lower in KC (7.6%, controls=
11%) but not sig. different.
PT , RCT, less infections in KMC at 1 year of age- secondary to BF
Rev of PT KC in developing countries and cites that KC has benefit of
fewer infections.
Just reporting that they will look at infection rate, no evidence to
support reduced infection in 24/7 KMC infants
Not meta-analysis results, but findings of the seven new studies they
examined are that infections decrease in KC group
PT, Cochrane Meta-analysis of 1362 24/7 KMC infants in 3 studies
(same as reported before). KMC infants are at less risk of nosocomial
infection and lower respiratory tract disease at 6 months.
PT, Cochrane meta-analysis, risk of infection is lower in KC infants
Review of reasons why KC at birth is good, and reduction in infections
is one of the reasons for Lamaze’s support for normal birth position
paper
Review of how KC reduces infections and why it is important to use in
community settings to prevent infections in newborns
PT, VLBW RCT. KC was routine, standard care and infants who got
KC + massage had fewer infections than KC alone group.
FT. One step mentions “The baby’s risk of infection is reduced because
safe germs (bacteria) from the mother start to colonize her skin and
intestines, and prevent harmful germs from growing”(pg. 12)..
Quotes Dr.Ludington as saying KC reduces infections and this is for
consumers in MOTHERING magazine.
PT, descriptive of 50 infants getting 4-6 hrs/day til discharge. No
infections during KC.
PT review of Sloan, Charpak 97 & 01 showing decreased infections
PT, reviews L-H’s Developmental Care chapter and relates decreased
infection in PT infants
PT, Clinical Report – “no evidence of increased risk of infection”
PT, 4/6 babies in KMC unit got TB from untreated TB active mother.
PT, in the book in chapter 10 on Respiration, it quote the meta-analysis
that show that KC reduces nosocomial infections.
Review, says KC at birth helps prevent infection. Same as Crenshaw
ref
PT, this review article is the same as Canadian Paediatric Society
position statement on KC which recommends KC for it nosocomial
infection reduction effects.
PT, chart review of 42 twins/2 triplets in 24/7 KC unit. 6 had to go to
NICU for sepsis, then returned to and discharged from KC unit
Kambarami et al, 1998
Kirsten & Kirsten 2000
Lamy Filho et al. 2013
Lawn et al., 2010
Lazarazo et al. 2012
Mendes & Procianoy 2009
Mendes & Procianoy, 2008
Rao et al., 2008
Schanler et al., 2005
Sizun et al., 2004
Sloan et al., 1994
Sosa et al., 1976
Suman et al. 2008
2013
PT, RCT, 37 KC (24/7 KC) infants “were ill less frequently” than 37
controls.
PT, RCT BF in KMC reduced incidence of NEC (10% vs 2.8%)
PT, RCT to determine if 28 hours of more of KMC over 7 days reduced
colonization of nostrils of infants who have MRSA. Both groups
reduced colonization, but twice as many KMCers did than controls.
Meta analysis of KMC. It is particularly effective in reducing severe
morbidity, particularly from infection.
PT, retrospective chart review of 374 24/7 KMC PTs who had shorter
length of stay, more stable temp and fewer nosocomial infections
PT, RCT, VLBW. Less infection in KC + massage group than in KC
alone group.
PT, RCT, VLBW. Less infection in KC+massage (4 times a day from
48 hours oflife until discharge) than KC alone infants.
PT, RCT, more controls than KMCers had nosocomial sepsis (p.19)
PT, RCT, infants in mother’s own milk group (who also got
significantly more episodes and significantly more duration of KC than
preterm formula and donor milk groups) had fewer infection events
(late onset sepsis, UTI, meningitis, NEC), but KC per se was not
correlated to number of infection-related events.
States that KC has shown fewer infections in developing countries but
that these findings may not be relevant in high tech countries. Cites
Charpak et al., 2001 as source of infection data.
PT, RCT, decrease in severe infections such as pneumonia, septicemia
in KMC infants over first 6 months of life
In all 3 RCTs, FT infants who got 45 min of KC beginning after
episiotomy repair had fewer episodes of infection (moniliasis,
impetigo, and medicated illness).
PT, FT (SGA) RCT of 24/7 KMC and KMC infants had fewer
infections than controls.
PT, reports that l hr of KMC in am and again in pm per day for 7 days
decolonized mrsa infected infants but controls also were decolonized
over this time period but were only half the number decolonized in the
KC group.
KC infants have more/more severe infections OR is risk factor for it
Sakaki et al., 2009
PT, Descriptive prospective study of incidence of MRSA among 961
infants. KMC was a predictor of MRSA.
Visser et al., 2008
PT, descriptive of 23 preterm infants who came down with nosocomial
RSV associated pneumonia one month after same strain appeared in
general pediatric ward of same hospital in Gauteng, South Africa.
There is also a reference for TB spreading in KMC wards
KC infants have no different infection rates than other infants/ no diff
between maternal & paternal KC on infection rates
Bauer, Sontheimer,et al., 1996
Cerezo & deLeon, 1992
Charpak et al., 1997
PT, VLBW, infection rate measured with maternal and paternal KC
No difference between mat/paternal KC and infection rate.
No sig diff by blood cultures and no sig diff in other cultures
PT, RCT, # & proportion of infectious episodes that had to be treated
during hospitalization was same, proportion of nosocomial infections
after eligibility and before discharge was less in KMC (3.8%) than
controls (7.8%, p=0.026)(pg. 685). Number of total infectious episodes
Filho et al. 2008
Ghavane et al. 2012
Kadam et al., 2005
that had to be treated in hospital was lower in KC (7.6%, controls=
11%) but not sig. different.
PT, clin eval of 8 NICUs with KC stepdown vs 8 units without KC
stepdown. No difference in infections between units.
PT, RCT micropreemie, no difference in infection rate between
24/7KMC unit and NICU incubator groups
PT, RCT. # of sepsis in KMC =6, control =8. 6 KMC babies transferred
back to regular care due to klebsiella pneumoniae. One KMC baby died
from sepsis. Overall, no sig diff in sepsis incidence.
Mechanisms by which KC affects infection
Abouelfettoh et al., 2010
Canadian Ped Society 2012
Darmstadt et al., 2000
Gangal, 2007
Odent, 1989
Schanler 2001
WHO 1998
PT, descriptive study of 5 days of KC effects on skin hydration
(increased) and TEWL (increased) and # of infections during
hospitalization and within one month of discharge (no infections after
KC).
PT, Position statement that reviews the fact that KC reduces
nosocomial infection and then talks about infants being colonized to
mother, no spreading of infection from one pair to another, and KC can
continue during infectious outbreaks.
Review of how KC reduces infections and why it is important to use in
community settings to prevent infections in newborns (Protection from
mother’s milk)
FT. One step mentions “The baby’s risk of infection is reduced because
safe germs (bacteria) from the mother start to colonize her skin and
intestines, and prevent harmful germs from growing”(pg. 12)..
FT, Clin Report- baby feeds at breast right after delivery in KC and
Gets lots of IgA antibodies and zinc and enzymes in colostrums.
PT, review article says that KC provides specific protection over
infection due to enteromammary pathway and possibly a dermal
pathway
FT. states that when a mother and her baby are in KC the baby is
exposed to the normal bacterial on t`e mother’s skin, whIch may
protect the baby from "becoming sick due to harmful germs.”
Related Issues: Staff Perception
Mallet et al., 2007
Trevisanuto et al., 2013
PT, Descriptive study of French NICU staff knowledge and barriers.
Fear of nosocomial infection is a barrier to KC use.
PT, 54 NICU providers ideas of what would reduce neonatal infections
in Vietnam included KMC as a priority for prevention and control of
infection in provincial hospitals in south and south central Vietnam.
Hand washing, exclusive breastfeeding and safe disposal of medical
waste were nominated by most participants as priorities for preventing
neonatal infections. Education through instructional posters and written
guidelines, family contact, kangaroo-mother-care, limitation of
invasive procedures and screening for maternal GBS infection were
advocated by a smaller proportion of participants.
Related Literature
InsTitute on Medicine, 2 02 Report of Preterm Birth conchudes that ‘stress’ and ‘infection’ contribute
to"the racial-ethnic difference in infant mortality rate.
Pammi, M., Abrams, SA. (2011) Oral lactoferrin fov the prevention of sepsis and necrotizing enterocolitis
in preterm infants. Cochrane Database Syst Review Oct. 5 (10): CD00711177
Lactoferrin is a normal component of COLostrRUM, human milk, human
saliva and tears. Oral lactoferrin reduces late-onset sepsis in VLBW infants