For babies born early, their first few days on Earth can be hostile.
Neonatal wards throughout the world harbor dangerous, drug-resistant microbes. Some of these bugs are found almost exclusively in these settings and rarely infect adults, posing the most threat to these infants. And they can be deadly.
These infections are increasingly hard to treat and even harder to get rid of on the wards.
Faced with this growing problem, researchers and doctors are experimenting with new ways to try to prevent infections among newborns. And one approach — administering probiotics — is showing promise.
It’s a small glimmer of hope. But currently, for babies placed in intensive care, the risk of dying from sepsis from one of these bacterial infections is growing as antibiotics increasingly don’t work.
A 2022 study of 3,200 newborns throughout the world found that 15 percent of babies with neonatal sepsis were prescribed last-resort antibiotics, suggesting doctors had tried a host of drugs without success.
It’s an “alarming” finding, the authors said, that “foretells the impending crisis of a lack of antibiotics to treat sepsis caused by multidrug-resistant organisms.”
Among these infections is one that is leaving scientists with a myriad of questions.
A unique challenge
“There’s a global superbug that people don’t know about that’s causing infection in neonatal intensive care units,” Mark Webber, researcher at the Quadram Institute research center in the United Kingdom, told POLITICO.
Webber is part of a team that has studied the characteristics and spread of this bug — known as NRCS-A, a clone of the bacteria Staphylococcus capitis. This multidrug-resistant bug is increasingly associated with sepsis that develops in newborns at least 72 hours after birth.
It was first identified in France about 10 years ago, but it’s likely been around much longer. Before long, clinicians and researchers realized the bug was present in neonatal intensive care units across the globe.
“This clone has gone global,” said Webber, “but the question is still, why? And that’s what’s unclear.”
NRCS-A rarely causes infections in adults; instead it has become “very, very good at infecting premature babies,” Webber said. While the clone is not necessarily more virulent than others, it is resistant to antibiotics and tolerant to antiseptics which allows it to survive on surfaces despite sanitization efforts. This makes it harder to treat.
Scientists have also hypothized that the bug is so good at spreading because it can survive both on the baby’s skin and in its gut.
“We think it’s likely it can hide in the gut, which then means that you get rid of it in the baby’s skin, maybe, but you don’t actually decolonize the baby,” Webber said, meaning it continues to pass into the environment.
In a 2023 study conducted on neonatal intensive care units (NICUs) in the U.K., scientists sampled 173 surfaces and found Staphylococcus capitis on 21 percent of them — 75 percent of which was the NRCS-A clone. They found that the bug was usually in the immediate neonatal bed space, and that incubators and other bedside equipment were also contaminated.
“It’s pretty much in all NICUs,” Webber said. “Even if they haven’t had any reported infection, it’s pretty much in the environment. So we need to do better at getting it out from the environment.”
A glimmer of hope
Amid lagging research and development for new antibiotics — especially for babies — scientists are looking for alternative ways to protect newborns against this threat, including the use of probiotics.
Babies are, in effect, born sterile; they have not yet developed a microbiome of bacteria and other microbes in their gut, mouths and skin, pointed out Lindsay Hall, chair of microbiome research at the University of Birmingham.
And for babies born prematurely and put straight into incubators, often their first dose of microbes is from their intensive care environment and carers.
Microbes in any environment will compete for food and space. Therefore, Hall and her colleagues are looking at whether giving babies a dose of protective bacteria can help prevent infection with the dangerous multidrug-resistant bugs.
They have been looking into the potential benefits of adding a probiotic supplement as a drop to the babies’ milk feed. They opted for adding Bifidobacterium probiotics because this is what is largely seen in healthy young infants, Hall said.
“When we then looked at their gut microbial profiles, they were then dominated by Bifidobacterium, and the levels of these potentially pathogenic, antimicrobial resistant bacteria were massively depleted,” Hall told POLITICO.
This happens because Bifidobacterium, in breaking down the sugar in breast milk, strengthens the barrier against bacteria. It also makes the gut environment more acidic and therefore less hospitable for bacteria such as E. Coli and Klebsiella, Hall said.
The researchers then tested whether giving this probiotic can help to prevent sepsis and necrotizing enterocolitis (NEC) — an infectious disease among babies and premature infants, with a mortality rate as high as 50 percent in some parts of the world.
They found that giving probiotics as routine care can reduce NEC mortality by about 50 percent — from 7.5 percent to 3.1 percent — according to the study conducted at Norfolk and Norwich University Hospitals. “I think it is really, really promising,” Hall said.
While the results have been acknowledged by the World Health Organization, and this practice adopted in several hospitals in the U.K. and Europe, the death of a premature baby in the U.S. due to sepsis caused by a probiotic has highlighted that no intervention is without risks.
It’s a setback for Hall and her colleagues, but it isn’t deterring them from their research.
Ultimately, the goal is to “prevent the infection, and you don’t need to treat the infection,” she said. “That’s what we want. That’s the ideal.”
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