LATE-ONSET NEONATAL SEPSIS: HEALTHCARE-ASSOCIATED INFECTION AND PREVENTION STRATEGIES IN THE NEONATAL INTENSIVE CARE UNIT

Abstract

Late-onset neonatal sepsis remains a major challenge in neonatal intensive care units because the same technologies that sustain extremely preterm and critically ill newborns also increase exposure to invasive devices, repeated handling and antimicrobial pressure. This narrative review critically analyzes the relationship between late-onset sepsis and healthcare-associated infection and discusses prevention strategies applicable to neonatal intensive care. Searches were performed in 2026 in PubMed/MEDLINE and SciELO, with complementary consultation of BVS/LILACS and institutional documents from the Brazilian Health Regulatory Agency and the World Health Organization. Recent systematic reviews, meta-analyses, guidelines and relevant observational or quality-improvement studies were prioritized. The evidence indicates that late-onset sepsis is not synonymous with healthcare-associated infection; although prematurity and prolonged hospitalization increase vulnerability, exposure to central venous catheters, mechanical ventilation and high-intensity care constitutes a modifiable component of risk. The most consistent approach is multimodal: hand hygiene, standardized insertion and maintenance bundles for central lines, reduction of unnecessary device exposure, neonatal-specific respiratory care bundles, human milk feeding, antimicrobial stewardship, adequate staffing, surveillance and audit with feedback. Isolated measures tend to be less sustainable than coordinated programs adapted to local microbiology and workflow. Prevention therefore depends on reliable systems of care rather than a single intervention, with continuous measurement of process adherence and infection outcomes.