Research In Practice Blog

Clinician in operation room with mask and protective equipment on
The Impact of Infection Prevention Measures Adopted During COVID-19 on Health Care Associated Infections for Infants in the NICU
Share  
By Sagori Mukhopadhyay, MD, MMSc, Dustin Daniel Flannery, DO, MSCE and Atyia Collins

Intro: Reducing Neonatal Infections

Infants admitted to the neonatal intensive care unit (NICU) can encounter severe complications due to health care-associated infections (HAI).  Research has demonstrated the effectiveness of infection prevention control measures in reducing the risk for HAI; however, data supporting specific infection control strategies for the NICU is limited.

During the pandemic, enhanced infection prevention measures were implemented across NICUs in United States including universal masking, changes to staff and visitor health screening, reinforced hand hygiene practices, and restricted visitation policies. In work was recently published in JAMA Network Open in a new study titled, “Health Care–Associated Infections Among Neonates During the COVID-19 Pandemic” a research team, including Clinical Futures experts, investigated whether these enhanced infection prevention measures impacted incidence of viral and non-viral HAI.

Sagori Mukhopadhyay, MD, MMSc, is an attending neonatologist at the Children's Hospital of Philadelphia (CHOP) and a Core Faculty member at Clinical Futures, a CHOP Research Institute Center of Emphasis. She was the principal investigator of this study, funded by the Gerber Foundation. Dr. Mukhopadhyay’s primary research goal is to improve infection prevention and management in neonates. Her work at Clinical Futures has focused on the effects of neonatal infections and antimicrobial therapy on early colonization, and how these factors impact health outcomes later in life. The research team included CHOP and Clinical Futures experts Dustin Flannery, DO, MSCE, Lakshmi Srinivasan, MBBS, MSTR, and Miren Dhudasia, MBBS, MPH. Data from 12 NICUs across the US and Canada, including the CHOP was assessed.

Results: Exploring the Impact of Infection Prevention Control Measures

Researchers compared the viral and bacterial or fungal HAI rates of infants admitted to the NICU before the COVID-19 pandemic (March 1, 2018- March 31, 2020) and during the COVID-19 pandemic (April 1, 2020-July 31, 2022). The observational cohort study was conducted across 12 NICUs in the US and Canda and a total cohort of 48,475 infants admitted during this period. The proportion of infants with viral HAI decreased from 0.8% before the pandemic to 0.3% during the pandemic. Rhinovirus and/or enterovirus were the most frequent both before and during the pandemic, followed by parainfluenza virus before the pandemic and SARS-CoV-2 during the pandemic.  

“Viral health care-associated infection rates decreased significantly in 4 of the 11 sites and did not increase for any site. This decrease persisted even in the second year of the pandemic. This data supports the role of pandemic-related infection prevention measures, such as masking and visitor screening, in reducing rates of viral health care-associated acquired infection among neonatal patients,” said Dr. Sagori Mukhopadhyay.  

Researchers found little change in the instances of bacterial or fungal healthcare-associated infections (HAIs) before (3.1%) and after (3.0%) the pandemic. It was hypothesized that universal masking would reduce the transmission of Staphylococcus aureus; however, researchers did not observe this association. Instead, an increase in non-CONS- gram positive BSI and/or meningitis was identified. High rates of Staphylococcus aurues have been reported in health care settings, attributed to mask contamination and increased burden of Staphylococcus aureus in the nasal microbiome. Researchers suggest further investigation to understand that pros and cons of masking.

What’s Next: Creating Strategies for Future Care

The study results indicate a decrease in viral HAI rates among infants admitted to the NICU during the COVID-19 pandemic, specifically for rhinovirus and/or enterovirus infections, although bacterial and anti-fungal HAI rates remained unchanged.  

“During a season with a high burden of viral diseases, implementing infection prevention measures utilized during COVID-19 like masking and visitor restrictions can help to decrease the incidence of healthcare-acquired infections of infants admitted to the NICU. However, in the case of bacterial or fungal HAI, further strategies are needed to make a difference in rates,” said Dr. Mukhopadhyay. 

Clinical Futures authors: Sagori Mukhopadhyay, MD, MMSc; Miren B. Dhudasia, MBBS, MPH; Dustin D. Flannery, DO, MSCE

Citation: 
Mukhopadhyay S, Conaway M, Dhudasia MB, et al. Health Care–Associated Infections Among Neonates During the COVID-19 Pandemic. JAMA Netw Open. 2026;9(1):e2555623. doi:10.1001/jamanetworkopen.2025.55623