The bacterium Staphylococcus aureus, often called Staph, commonly resides harmlessly on the skin or in the nose of approximately one-third of healthy adults. While colonization is benign in older children, it can cause illness when it infects a newborn. Infants are vulnerable because their immune systems are underdeveloped, and their skin barrier is thinner. This allows Staph to penetrate the body more easily, potentially leading to complications. Recognizing the signs of this infection in the neonatal period is important for prompt medical intervention.
Recognizing the Signs of Infection
Staph infections in newborns frequently begin as localized skin issues, the most common presentation. These infections can appear as small, pus-filled bumps or blisters, sometimes resembling pimples. A superficial skin infection called impetigo is common, characterized by open sores that often develop a honey-colored crust.
A more serious, localized infection can manifest as a boil (furuncle), a pink or red abscess that is warm and painful. These infections can progress to cellulitis, where the affected area becomes red, swollen, and tender as the bacteria spread into the deeper skin layers. Any rapidly spreading redness or the presence of pus or fluid draining from a skin lesion warrants immediate medical attention.
Another severe manifestation is Staphylococcal Scalded Skin Syndrome (SSSS), which results from toxins spreading through the bloodstream. SSSS typically begins with non-specific symptoms like fever, fussiness, and lethargy. Within 24 to 48 hours, a painful, widespread red rash develops, followed by the formation of fragile, fluid-filled blisters.
These blisters easily rupture, causing the top layer of skin to peel away in sheets, leaving the skin raw and red, much like a burn. The peeling results from the Staph toxin attacking a protein responsible for skin cell adhesion. SSSS requires hospitalization, as the loss of the protective skin barrier can lead to dehydration and further infection.
Beyond the skin, Staph can cause systemic illness when the bacteria enter the bloodstream and spread throughout the body. Signs of systemic infection, which can lead to sepsis, include lethargy, poor feeding, and irritability. The newborn may also exhibit an unstable body temperature, presenting as either a high fever (hyperthermia) or an abnormally low temperature (hypothermia). Other signs include a rapid or slow heart rate and difficulty breathing.
Specific sites where infection is often seen are the umbilical cord stump and circumcision site. Infection at these sites, known as omphalitis, is indicated by severe redness, swelling, or discharge.
How Newborns Contract Staph
Staph bacteria are often transmitted to newborns through contact with colonized individuals who are not ill. Many healthy adults, including parents and hospital staff, carry S. aureus without showing signs of infection. Transmission can occur vertically, when the mother transfers the bacteria to the infant during birth. Horizontal transmission occurs when caregivers handle the infant without adequate hand hygiene. The bacteria can transfer from hands, clothing, or contaminated surfaces, such as changing tables or medical equipment.
In Neonatal Intensive Care Units (NICUs), the risk is elevated for premature or low-birth-weight infants who require extended hospital stays or invasive procedures, such as catheters or ventilators. The bacteria enter the newborn’s body through breaks in the skin barrier, like minor cuts, or the vulnerable sites of the umbilical cord and circumcision. Exposure to contaminated breast milk due to improper cleaning of pumping equipment has also been reported.
Medical Response and Treatment
Once a Staph infection is suspected, the initial step involves obtaining a sample for diagnostic confirmation. Doctors typically perform a culture by swabbing the affected skin lesion, the umbilical stump, or the nose. If a systemic infection is suspected, blood or cerebrospinal fluid samples may be collected to identify the bacteria and determine its sensitivity to antibiotics. The results of these tests guide the treatment plan, which is often implemented immediately, even before the culture results are finalized.
Treatment for Staph infections varies depending on the severity and location of the illness. Localized skin infections, such as impetigo, may be treated with topical antibiotic ointments or oral antibiotics, like cephalexin. If an abscess or boil has formed, the physician may need to drain the pus alongside antibiotic administration.
Systemic infections, including sepsis or SSSS, require immediate hospitalization for close monitoring and treatment. These conditions are managed with intravenous (IV) antibiotics to ensure the medication reaches the bloodstream quickly. Given the potential for rapid progression in newborns, fluid replacement and specialized skin care, often in a burn or intensive care unit, are sometimes necessary for SSSS patients.
A concern in treating Staph infections is the possibility of Methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a strain that has developed resistance to several common antibiotics, including methicillin. If MRSA is suspected or confirmed, specialized antibiotics, such as vancomycin or linezolid, are required. Prompt identification of MRSA is important, as it requires a different antibiotic strategy than methicillin-susceptible Staph.
Preventing Staph Infections in Infants
The most effective strategy for preventing Staph transmission is consistent practice of hand hygiene by all caregivers. Frequent handwashing with soap and water or the use of an alcohol-based sanitizer before and after contact with the infant is recommended. This action minimizes the risk of transferring bacteria from colonized skin or contaminated surfaces.
Parents should pay careful attention to the care of the infant’s skin, especially the umbilical cord and any circumcision site. These sites should be kept clean and dry according to pediatric guidance to reduce pathways for bacterial entry. Maintaining a clean environment by regularly disinfecting surfaces and cleaning feeding equipment also contributes to risk reduction.
Caregivers who have open cuts, wounds, or active skin infections should ensure these areas are kept covered with clean bandages. Avoiding contact between the infant and individuals who are ill or have draining lesions helps prevent transmission. In hospital settings, screening infants for colonization with Staph or MRSA and implementing decolonization protocols using antiseptic washes are proactive measures.