Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101667
Nestor E. Vain , Paolo Manzoni , Kee Thai Yeo
Prevention of RSV lower respiratory tract infections (LRTI) in infants has been limited to general measures and palivizumab, a monoclonal antibody indicated for the highest risk groups. Recently developed RSV vaccines used during pregnancy generate antibodies that cross the placenta. Randomized controlled trials (RCT) and real-life monitoring have demonstrated their effectiveness in protecting newborns and infants during the first months of life. Likewise, novel extended half-life monoclonal antibodies, nirsevimab and the recently approved clesrovimab, opened the possibility of large-scale protection targeted to all infants born during the winter season and those <6 months at the beginning of it. Several RCTs and results from populations adopting nirsevimab prophylaxis demonstrated a large decrease in the incidence of RSV-LRTIs and a great impact in infant public health. Deployment of either strategies or in combination as part of immunization programs can be complement each other even as newer immunologic agents are being introduced.
{"title":"Respiratory syncytial virus. What's new in prevention?","authors":"Nestor E. Vain , Paolo Manzoni , Kee Thai Yeo","doi":"10.1016/j.siny.2025.101667","DOIUrl":"10.1016/j.siny.2025.101667","url":null,"abstract":"<div><div>Prevention of RSV lower respiratory tract infections (LRTI) in infants has been limited to general measures and palivizumab, a monoclonal antibody indicated for the highest risk groups. Recently developed RSV vaccines used during pregnancy generate antibodies that cross the placenta. Randomized controlled trials (RCT) and real-life monitoring have demonstrated their effectiveness in protecting newborns and infants during the first months of life. Likewise, novel extended half-life monoclonal antibodies, nirsevimab and the recently approved clesrovimab, opened the possibility of large-scale protection targeted to all infants born during the winter season and those <6 months at the beginning of it. Several RCTs and results from populations adopting nirsevimab prophylaxis demonstrated a large decrease in the incidence of RSV-LRTIs and a great impact in infant public health. Deployment of either strategies or in combination as part of immunization programs can be complement each other even as newer immunologic agents are being introduced.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101667"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101662
Yarlini Vipulanandan, Suresh Boppana, Karen B. Fowler, David W. Kimberlin
Congenital cytomegalovirus (CMV) infection is a large contributor to neurodevelopmental delay and non-genetic sensorineural hearing loss, which can often be delayed in onset. While a majority of CMV infections are asymptomatic in healthy children and adults, periconceptual and early in utero infection can cause clinically significant and potentially long-term sequelae. The complex relationship between congenital CMV infection and maternal immunity provides a challenging backdrop for CMV prevention. Increased awareness of the significance of congenital CMV is reflected in the proliferation of prevention strategies over the past 30 years, including education initiatives, behavioral modifications, and maternal antiviral prophylaxis. This review explores different levels of congenital CMV prevention and highlights a variety of prevention strategies, including the potential for development of effective vaccines for CMV.
{"title":"Advancements and potential in the prevention of congenital CMV infection","authors":"Yarlini Vipulanandan, Suresh Boppana, Karen B. Fowler, David W. Kimberlin","doi":"10.1016/j.siny.2025.101662","DOIUrl":"10.1016/j.siny.2025.101662","url":null,"abstract":"<div><div>Congenital cytomegalovirus (CMV) infection is a large contributor to neurodevelopmental delay and non-genetic sensorineural hearing loss, which can often be delayed in onset. While a majority of CMV infections are asymptomatic in healthy children and adults, periconceptual and early in utero infection can cause clinically significant and potentially long-term sequelae. The complex relationship between congenital CMV infection and maternal immunity provides a challenging backdrop for CMV prevention. Increased awareness of the significance of congenital CMV is reflected in the proliferation of prevention strategies over the past 30 years, including education initiatives, behavioral modifications, and maternal antiviral prophylaxis. This review explores different levels of congenital CMV prevention and highlights a variety of prevention strategies, including the potential for development of effective vaccines for CMV.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101662"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101669
Isabelle Ommert , Caroline-Aleksi Mägi , Siri Lilliesköld , Ylva Thernström Blomqvist , Anna Axelin , Agnes Linnér
Late onset sepsis is a major cause of morbidity and mortality in the neonatal intensive care unit, and it is frequently acquired from the environment. Infant- and family-centered developmental care, which involves skin-to-skin contact, breastfeeding and continuous parental participation in the care, is an effective infection prevention strategy. Kangaroo mother care, including skin-to-skin contact supports the development of a diverse skin microbiome, distinct from that of the hospital environment. Breastmilk further contributes to infection prevention and immune system development through multiple mechanisms. Parental involvement may improve the safety and quality of care delivery by hospital staff. In summary, parents play an important role in infection prevention in the neonatal intensive care unit. The risks of not including parents in the care of their infants should be further considered both in research and clinical practice.
{"title":"The role of parents to prevent infections in the neonatal intensive care unit","authors":"Isabelle Ommert , Caroline-Aleksi Mägi , Siri Lilliesköld , Ylva Thernström Blomqvist , Anna Axelin , Agnes Linnér","doi":"10.1016/j.siny.2025.101669","DOIUrl":"10.1016/j.siny.2025.101669","url":null,"abstract":"<div><div>Late onset sepsis is a major cause of morbidity and mortality in the neonatal intensive care unit, and it is frequently acquired from the environment. Infant- and family-centered developmental care, which involves skin-to-skin contact, breastfeeding and continuous parental participation in the care, is an effective infection prevention strategy. Kangaroo mother care, including skin-to-skin contact supports the development of a diverse skin microbiome, distinct from that of the hospital environment. Breastmilk further contributes to infection prevention and immune system development through multiple mechanisms. Parental involvement may improve the safety and quality of care delivery by hospital staff. In summary, parents play an important role in infection prevention in the neonatal intensive care unit. The risks of not including parents in the care of their infants should be further considered both in research and clinical practice.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101669"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101666
Ashraf Kharrat , Najla Tabbara , Prakesh S. Shah
Antimicrobial resistance is an evolving threat to infants admitted to the neonatal intensive care unit. Antibiotic-resistant organisms may colonize infants, cause infections, or contribute to nosocomial outbreaks, and are associated with infant morbidity and mortality. As microorganisms continue to acquire resistance to available antimicrobials, infants become at risk of therapeutic failure. One key strategy to prevent the development of antimicrobial resistance is through antimicrobial stewardship to optimize antimicrobial use. This review starts with an overview of neonatal sepsis and drivers of antimicrobial resistance. It subsequently discusses strategies to address and minimize the burden and transmission of antibiotic-resistance organisms as well as implement antimicrobial stewardship programs in the neonatal intensive care unit.
{"title":"Antibiotic stewardship in the neonatal intensive care unit and prevention of antimicrobial resistance","authors":"Ashraf Kharrat , Najla Tabbara , Prakesh S. Shah","doi":"10.1016/j.siny.2025.101666","DOIUrl":"10.1016/j.siny.2025.101666","url":null,"abstract":"<div><div>Antimicrobial resistance is an evolving threat to infants admitted to the neonatal intensive care unit. Antibiotic-resistant organisms may colonize infants, cause infections, or contribute to nosocomial outbreaks, and are associated with infant morbidity and mortality. As microorganisms continue to acquire resistance to available antimicrobials, infants become at risk of therapeutic failure. One key strategy to prevent the development of antimicrobial resistance is through antimicrobial stewardship to optimize antimicrobial use. This review starts with an overview of neonatal sepsis and drivers of antimicrobial resistance. It subsequently discusses strategies to address and minimize the burden and transmission of antibiotic-resistance organisms as well as implement antimicrobial stewardship programs in the neonatal intensive care unit.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101666"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101664
Kia Hee Schultz Dungu , Emma Louise Malchau Carlsen , Olav Bjørn Petersen , Nadja Hawwa Vissing , Ulrikka Nygaard
Neonatal herpes simplex virus (HSV) infection remains a life-threatening condition with high morbidity and mortality despite advances in diagnostics and therapy. Transmission occurs predominantly during delivery and the three main clinical phenotypes; skin-eye-mouth disease, central nervous system disease, and disseminated disease, carry distinct prognoses. This state-of-the-art review focuses on prevention and consideration of empirical treatment. Maternal antiviral prophylaxis in late pregnancy has shown to reduce the frequency of active HSV outbreaks at delivery. Decisions on empirical acyclovir therapy must balance early recognition against overtreatment, guided by the number needed to treat, which in European settings among term and near-term infants ranges from over 1,000 for early-onset sepsis to ∼150 for late-onset sepsis. Ongoing research focuses on preventive strategies, including vaccine development and novel biomarkers on dried blood spot samples to improve outcomes.
{"title":"Herpes simplex virus – state of the art of prevention and treatment","authors":"Kia Hee Schultz Dungu , Emma Louise Malchau Carlsen , Olav Bjørn Petersen , Nadja Hawwa Vissing , Ulrikka Nygaard","doi":"10.1016/j.siny.2025.101664","DOIUrl":"10.1016/j.siny.2025.101664","url":null,"abstract":"<div><div>Neonatal herpes simplex virus (HSV) infection remains a life-threatening condition with high morbidity and mortality despite advances in diagnostics and therapy. Transmission occurs predominantly during delivery and the three main clinical phenotypes; skin-eye-mouth disease, central nervous system disease, and disseminated disease, carry distinct prognoses. This state-of-the-art review focuses on prevention and consideration of empirical treatment. Maternal antiviral prophylaxis in late pregnancy has shown to reduce the frequency of active HSV outbreaks at delivery. Decisions on empirical acyclovir therapy must balance early recognition against overtreatment, guided by the number needed to treat, which in European settings among term and near-term infants ranges from over 1,000 for early-onset sepsis to ∼150 for late-onset sepsis. Ongoing research focuses on preventive strategies, including vaccine development and novel biomarkers on dried blood spot samples to improve outcomes.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101664"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101681
Tobias Strunk , Jakob Steer , Andrew Currie
The neonatal skin is central to early survival and immune development. Far from being a passive mechanical barrier, it integrates physical, chemical, and microbial defences that together protect the infant in the immediate postnatal period. In preterm infants, structural immaturity, reduced antimicrobial capacity, and altered microbial colonisation confer heightened vulnerability to infection and inflammation. At the same time, the neonatal period represents a critical window during which skin–microbe interactions shape tolerance and long-term immune trajectories. This review summarises recent advances in understanding the development of the skin barrier, antimicrobial and innate immune defences, and the role of commensals in immune programming. Translational opportunities for neonatal care are discussed, including skin protective practices, antisepsis, and emollient use that may reduce infection risk in the neonatal intensive care unit. Finally, we consider future directions in microbiome-informed and skin-centred strategies.
{"title":"Neonatal skin: barrier, immunity and infection prevention in the NICU","authors":"Tobias Strunk , Jakob Steer , Andrew Currie","doi":"10.1016/j.siny.2025.101681","DOIUrl":"10.1016/j.siny.2025.101681","url":null,"abstract":"<div><div>The neonatal skin is central to early survival and immune development. Far from being a passive mechanical barrier, it integrates physical, chemical, and microbial defences that together protect the infant in the immediate postnatal period. In preterm infants, structural immaturity, reduced antimicrobial capacity, and altered microbial colonisation confer heightened vulnerability to infection and inflammation. At the same time, the neonatal period represents a critical window during which skin–microbe interactions shape tolerance and long-term immune trajectories. This review summarises recent advances in understanding the development of the skin barrier, antimicrobial and innate immune defences, and the role of commensals in immune programming. Translational opportunities for neonatal care are discussed, including skin protective practices, antisepsis, and emollient use that may reduce infection risk in the neonatal intensive care unit. Finally, we consider future directions in microbiome-informed and skin-centred strategies.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101681"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101682
David A. Kaufman
In the past decades more infants of lower gestational ages (GAs) have developed invasive Candida infection (ICI) from nonmodifiable risk factors of immature immunity and underdeveloped immune barriers (skin, gastrointestinal and respiratory tracts). Rates of ICI vary secondary to modifiable clinical practices, resuscitation practices and the nonmodifiable factor of the number of infants cared for at the lowest GAs of 22–24 weeks. Standardization of ICI definitions and reporting by each GA are needed to optimally elucidate actual rates, outcomes and differences across units, countries and regions. In extremely low birth weight (ELBW, <1000 g at birth) infants with ICI, mortality and neurodevelopmental impairment (NDI) have remained high despite appropriate antifungal therapy and (if candidemia) prompt removal of central venous catheters (CVC). Targeted fluconazole prophylaxis (3 or 6 mg/kg) twice a week in high-risk ELBW infants has been shown to be effective in preventing ICI and is safe without the emergence of azole resistance. Compared to nystatin, fluconazole prophylaxis for ELBW infants is more effective in preventing ICI and since it can be given intravenously, it is not dependent on enteral feeding status. Risk factors (e.g., receiving treatment with antibiotics or parenteral nutrition, presence of a CVC, vaginal delivery) can be used to both identify high-risk patients and define the time period when antifungal prophylaxis is beneficial. Independently of GA, high-risk infants also include those receiving third and fourth generation cephalosporins or carbapenems and those with complex gastrointestinal conditions (e.g. necrotizing enterocolitis, bowel perforation, gastroschisis).
{"title":"Antifungal prophylaxis-Where are we today?","authors":"David A. Kaufman","doi":"10.1016/j.siny.2025.101682","DOIUrl":"10.1016/j.siny.2025.101682","url":null,"abstract":"<div><div>In the past decades more infants of lower gestational ages (GAs) have developed invasive <em>Candida</em> infection (ICI) from nonmodifiable risk factors of immature immunity and underdeveloped immune barriers (skin, gastrointestinal and respiratory tracts). Rates of ICI vary secondary to modifiable clinical practices, resuscitation practices and the nonmodifiable factor of the number of infants cared for at the lowest GAs of 22–24 weeks. Standardization of ICI definitions and reporting by each GA are needed to optimally elucidate actual rates, outcomes and differences across units, countries and regions. In extremely low birth weight (ELBW, <1000 g at birth) infants with ICI, mortality and neurodevelopmental impairment (NDI) have remained high despite appropriate antifungal therapy and (if candidemia) prompt removal of central venous catheters (CVC). Targeted fluconazole prophylaxis (3 or 6 mg/kg) twice a week in high-risk ELBW infants has been shown to be effective in preventing ICI and is safe without the emergence of azole resistance. Compared to nystatin, fluconazole prophylaxis for ELBW infants is more effective in preventing ICI and since it can be given intravenously, it is not dependent on enteral feeding status. Risk factors (e.g., receiving treatment with antibiotics or parenteral nutrition, presence of a CVC, vaginal delivery) can be used to both identify high-risk patients and define the time period when antifungal prophylaxis is beneficial. Independently of GA, high-risk infants also include those receiving third and fourth generation cephalosporins or carbapenems and those with complex gastrointestinal conditions (e.g. necrotizing enterocolitis, bowel perforation, gastroschisis).</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101682"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preterm infants, who represent around 10 % of births worldwide, are at markedly increased risk of infections due to their immunological immaturity and reduced maternal antibody transfer. Although international guidelines recommend immunization based on chronological age, vaccination in this population is frequently delayed or incomplete. This review summarizes the current evidence on vaccine safety, efficacy, and timing in preterm infants, with particular emphasis on primary immunizations and vaccines administered during the first year of life. Distinct immunological characteristics—including impaired T- and B-cell responses as well as altered microbiome development—contribute to reduced vaccine responsiveness. Emerging approaches such as mRNA vaccine technologies, novel adjuvants, maternal immunization, and microbiome modulation hold promise for enhancing vaccine efficacy. Ensuring timely immunization and adherence to vaccination recommendations in preterm infants is essential to reduce preventable morbidity and mortality in this highly vulnerable group.
{"title":"Vaccinations in preterm infants: Which and when?","authors":"Charline Schmitt , Sybelle Goedicke-Fritz , Ingmar Fortmann , Michael Zemlin","doi":"10.1016/j.siny.2025.101670","DOIUrl":"10.1016/j.siny.2025.101670","url":null,"abstract":"<div><div>Preterm infants, who represent around 10 % of births worldwide, are at markedly increased risk of infections due to their immunological immaturity and reduced maternal antibody transfer. Although international guidelines recommend immunization based on chronological age, vaccination in this population is frequently delayed or incomplete. This review summarizes the current evidence on vaccine safety, efficacy, and timing in preterm infants, with particular emphasis on primary immunizations and vaccines administered during the first year of life. Distinct immunological characteristics—including impaired T- and B-cell responses as well as altered microbiome development—contribute to reduced vaccine responsiveness. Emerging approaches such as mRNA vaccine technologies, novel adjuvants, maternal immunization, and microbiome modulation hold promise for enhancing vaccine efficacy. Ensuring timely immunization and adherence to vaccination recommendations in preterm infants is essential to reduce preventable morbidity and mortality in this highly vulnerable group.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101670"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101680
Eva P. Galiza , Eve Nakebembe , Robert Mboizi , Erick Okek , Kirsty Le Doare
Maternal vaccination during pregnancy is emerging as a powerful strategy in protecting newborns from infectious diseases, improving neonatal outcomes, and potentially reducing antimicrobial use and resistance.
Maternal immunisation works by eliciting protective antibodies in the mother that are transferred to the fetus transplacentally and through breastmilk postnatally to provide the infant with passive immunity during the first vulnerable months of life. There is sufficient evidence to support the role of maternal vaccination in averting many neonatal infections that would otherwise require medical intervention.
By preventing infections in mothers and their newborn, maternal vaccination also holds significant potential for reducing antimicrobial use and antimicrobial resistance. Fewer neonatal infections translate to a reduced need for antimicrobial use in the neonatal period and in postpartum women, therefore lowering the selective pressure for drug-resistant bacteria.
Routine maternal vaccines (tetanus, diphtheria, acellular pertussis (Tdap), influenza, COVID-19, respiratory syncytial virus) already confer measurable antibiotic-sparing benefits by preventing infections that typically trigger antimicrobial therapy in mothers and neonates. Pipeline candidates (Group B Streptococcus, Klebsiella pneumoniae, Escherichia coli) could further lower neonatal sepsis burden, reducing broad-spectrum antimicrobial use in neonatal intensive care units to help slow antimicrobial resistance. Integrated with antibiotic stewardship and infection-prevention measures, maternal immunisation offers a practical, scalable practice to limit perinatal antibiotic exposure.
{"title":"Maternal vaccination to prevent neonatal infections and combat antimicrobial resistance","authors":"Eva P. Galiza , Eve Nakebembe , Robert Mboizi , Erick Okek , Kirsty Le Doare","doi":"10.1016/j.siny.2025.101680","DOIUrl":"10.1016/j.siny.2025.101680","url":null,"abstract":"<div><div>Maternal vaccination during pregnancy is emerging as a powerful strategy in protecting newborns from infectious diseases, improving neonatal outcomes, and potentially reducing antimicrobial use and resistance.</div><div>Maternal immunisation works by eliciting protective antibodies in the mother that are transferred to the fetus transplacentally and through breastmilk postnatally to provide the infant with passive immunity during the first vulnerable months of life. There is sufficient evidence to support the role of maternal vaccination in averting many neonatal infections that would otherwise require medical intervention.</div><div>By preventing infections in mothers and their newborn, maternal vaccination also holds significant potential for reducing antimicrobial use and antimicrobial resistance. Fewer neonatal infections translate to a reduced need for antimicrobial use in the neonatal period and in postpartum women, therefore lowering the selective pressure for drug-resistant bacteria.</div><div>Routine maternal vaccines (tetanus, diphtheria, acellular pertussis (Tdap), influenza, COVID-19, respiratory syncytial virus) already confer measurable antibiotic-sparing benefits by preventing infections that typically trigger antimicrobial therapy in mothers and neonates. Pipeline candidates (<em>Group B Streptococcus</em>, <em>Klebsiella pneumoniae</em>, <em>Escherichia coli</em>) could further lower neonatal sepsis burden, reducing broad-spectrum antimicrobial use in neonatal intensive care units to help slow antimicrobial resistance. Integrated with antibiotic stewardship and infection-prevention measures, maternal immunisation offers a practical, scalable practice to limit perinatal antibiotic exposure.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101680"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.siny.2025.101663
Juanita Lishman , Lars Naver , Helena Rabie
Vertical transmission of HIV to newborns and infants during pregnancy, labour and delivery, and breastfeeding ranges from 15 % to 45 % without intervention. The most important risk factor for transmission is a high maternal viral load. Prevention guidelines for low- and middle-income (high-burden) countries differ from those for high-income (lower-burden) settings, with a key differences in provision of caesarean section, post delivery antiretroviral care of the baby and infant feeding practice. This review will focus on a comprehensive approach to the elimination of paediatric HIV. We will discuss aspects of prevention of HIV and the current standards of care in the prevention of vertical transmission. We highlight the differences between well-resourced and lower-resourced settings including approaches to caesarean section and breastfeeding and infant prophylaxis. We also touch on the potential of emerging strategies to further reduce vertical transmission of HIV. Lastly, despite progress in prevention, challenges persist, particularly in sub-Saharan Africa due to structural health system gaps and loss to care. The recent reduction in donor funding threatens the progress made in transmission prevention.
{"title":"Current standards for HIV vertical transmission prevention","authors":"Juanita Lishman , Lars Naver , Helena Rabie","doi":"10.1016/j.siny.2025.101663","DOIUrl":"10.1016/j.siny.2025.101663","url":null,"abstract":"<div><div>Vertical transmission of HIV to newborns and infants during pregnancy, labour and delivery, and breastfeeding ranges from 15 % to 45 % without intervention. The most important risk factor for transmission is a high maternal viral load. Prevention guidelines for low- and middle-income (high-burden) countries differ from those for high-income (lower-burden) settings, with a key differences in provision of caesarean section, post delivery antiretroviral care of the baby and infant feeding practice. This review will focus on a comprehensive approach to the elimination of paediatric HIV. We will discuss aspects of prevention of HIV and the current standards of care in the prevention of vertical transmission. We highlight the differences between well-resourced and lower-resourced settings including approaches to caesarean section and breastfeeding and infant prophylaxis. We also touch on the potential of emerging strategies to further reduce vertical transmission of HIV. Lastly, despite progress in prevention, challenges persist, particularly in sub-Saharan Africa due to structural health system gaps and loss to care. The recent reduction in donor funding threatens the progress made in transmission prevention.</div></div>","PeriodicalId":49547,"journal":{"name":"Seminars in Fetal & Neonatal Medicine","volume":"30 4","pages":"Article 101663"},"PeriodicalIF":2.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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