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Potential NICU Environmental Influences on the Neonate's Microbiome: A Systematic Review

Hartz, Lacey E. MSN, RN, NNP-BC; Bradshaw, Wanda MSN, RN, NNP-BC, PNP; Brandon, Debra H. PhD, RN, CNS, FAAN

Section Editor(s): Gregory, Katherine E.

doi: 10.1097/ANC.0000000000000220
Special Series: Unraveling the Microbiome

Objective: To identify how the neonatal intensive care unit (NICU) environment potentially influences the microbiome high-risk term and preterm infants.

Data Sources: Electronic databases utilized to identify studies published in English included PubMed, Google Scholar, Cumulative Index for Nursing and Allied Health Literature, and BioMedSearcher. Date of publication did not limit inclusion in the review.

Study Selection: Two hundred fifty articles were assessed for relevance to the research question through title and abstract review. Further screening resulted in full review of 60 articles. An in-depth review of all 60 articles resulted in 39 articles that met inclusion criteria. Twenty-eight articles were eliminated on the basis of the type of study and subject of interest.

Data Extraction: Studies were reviewed for information related to environmental factors that influence microbial colonization of the neonatal microbiome. Environment was later defined as the physical environment of the NICU and nursery caregiving activities.

Data Synthesis: Studies were characterized into factors that impacted the infant's microbiome—parental skin, feeding type, environmental surfaces and caregiving equipment, health care provider skin, and antibiotic use.

Conclusions: Literature revealed that various aspects of living within the NICU environment do influence the microbiome of infants. Caregivers can implement strategies to prevent environment-associated nosocomial infection in the NICU such as implementing infection control measures, encouraging use of breast milk, and decreasing the empirical use of antibiotics.

Duke University School of Nursing, Durham, North Carolina (Mss Hartz and Bradshaw, and Dr Brandon); Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina (Dr Brandon).

Correspondence: Debra H. Brandon, PhD, RN, CNS, FAAN, Department of Pediatrics, Duke University School of Medicine, DUMC 3322, 307 Trent Dr, Durham, NC 27710.

The authors acknowledge that the preparation of this article was supported by the National Institute of Health, R01GM108494 (PI: P. Seed; Co-I: D. Brandon).

The authors declare no conflicts of interest.

© 2015 by The National Association of Neonatal Nurses