Infection risk is high because preterm infants have immature immune defenses, skin that is not fully developed and limited protective flora.1,([FOOTNOTE=Polin RA, Denson S, Brady MT, et al. Epidemiology and diagnosis of health care–associated infections in the NICU. Pediatrics. 2012;129(4):e1104-e1109.],[ANCHOR=],[LINK=]) They frequently need invasive procedures1 and may have in-dwelling catheters and tubes that act as portals to bring pathogens across protective barriers.2
The most common hospital-acquired NICU infections are bloodstream infections associated with the use of catheters.2,([FOOTNOTE=Polin RA, Denson S, Brady MT. Strategies for prevention of health care-associated infections in the NICU. Pediatrics. 2012:129:e1085-1093.],[ANCHOR=],[LINK=]) Lower respiratory tract infections and ventilator-associated pneumonia are frequent and can potentially be severe.2 These hospital-acquired infections can set back a neonate on the road to recovery1 and prolong their stay in the hospital.
The skin of premature neonates is not fully formed — it is approximately 40% to 60% thinner than adult skin — and not as capable of providing protection against environmental stressors.([FOOTNOTE=McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. Orthop Nurs. 2013;32(5):267-281.],[ANCHOR=],[LINK=]),([FOOTNOTE=Visscher M, Narendran V. The ontogeny of skin. Adv Wound Care. 2014;3:291-303.],[ANCHOR=],[LINK=]) The connection between the dermis and epidermis is fragile in neonates4 and they commonly develop skin and soft-tissue infections.1 In addtion, poor skin integrity is also a major risk factor for neonatal sepsis5 and pain and skin injury during adhesive removal.4 Loss of epidermal layers during adhesive removal can compromise the structural integrity of neonatal skin, resulting in increased skin permeability to pathogens and irritans, which can lead to potential toxicity and higher risk of infection.4
Preterm infants are born during a time of rapid brain development that includes development of synaptic connections and establishment of cortical networks.([FOOTNOTE=Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013;4(4):e0025.],[ANCHOR=],[LINK=]) These processes are affected by pain, which puts neurologically immature infants at risk for long-lasting consequences associated with neonatal pain.6
Preterm neonates are more sensitive to touch and pain than full-term babies.6 They also experience sensitization, in which earlier interventions can affect response to subsequent stimuli.6 For example, an infant who experiences a heel lance may respond to routine handling 30 minutes later as if it were an invasive procedure.6
Exposure to pain in preterm babies has been implicated in sensitization of pain pathways, as well as long-term alterations in brain structure, function, and neurodevelopment.6 These changes may contribute to the long-term difficulties in attention, executive functions, cognition, and behavioral problems associated with premature birth.6