Does the separation or grouping, or both of newborn infants in the newborn unit decrease spread of infections?

Key messages

We did not find any published or ongoing medical studies to answer our question. 

Future studies are needed to assess the usefulness of separating or grouping newborn babies in decreasing the spread of infections as well as the financial costs of doing so. 

What are healthcare-associated infections? 

Healthcare-associated infections (HAIs) are infections that patients develop during their stay in the hospital, which were not present before hospital admission. They commonly occur while receiving medical or surgical treatment although many HAIs are preventable. HAIs also include infections in newborn infants that happen around the time of delivery. 

Why is preventing HAIs important in newborns? 

HAIs increase health complications and can even lead to death. Additionally, HAIs result in increased hospital costs. 

What did we want to find out?

We wanted to find out if keeping infants with infections in separate rooms (single-room isolation) or grouped and cared for together (cohorting), or both will reduce the spread of the infection from one infant to another.

What did we do? 

We searched for studies that assessed isolation and grouping of infants in addition to the routine methods of infection control (e.g. hand washing, use of gowns and gloves, etc.). 

What did we find? 

Although single-room isolation and grouping practices are commonly followed in newborn units, we could not find any prior or ongoing studies that assessed the benefits of these measures in decreasing the spread of infection. We recommend that well-thought-out studies are needed to answer our review question given the importance of infection prevention and reducing healthcare costs. 

How up-to-date is this evidence? 

The evidence is up-to-date to November 2022.

Authors' conclusions: 

The review found no evidence from randomized trials to either support or refute the use of patient isolation measures (single-room isolation or cohorting) in neonates with HAIs. Risks secondary to infection control measures need to be balanced against the benefits of decreasing horizontal transmission in the neonatal unit for optimal neonatal outcomes. There is an urgent need to research the effectiveness of patient isolation measures for preventing the transmission of HAIs in neonatal units. Well-designed trials randomizing clusters of units or hospitals to a type of patient isolation method intervention are warranted.

Read the full abstract...

Neonatal healthcare-associated infections (HAIs) result in increased morbidity and mortality, as well as increased healthcare costs. Patient isolation measures, i.e. single-room isolation or the cohorting of patients with similar infections, remain a recommended and commonly used practice for preventing horizontal spread of infections in the neonatal intensive care unit (NICU). 


Our primary objective was to assess the effect of single-room isolation or cohorting, or both for preventing transmission of HAIs or colonization with HAI-causing pathogens in newborn infants less than six months of age admitted to the neonatal intensive care unit (NICU).

Our secondary objective was to assess the effect of single-room isolation or cohorting, or both on neonatal mortality and perceived or documented adverse effects in newborn infants admitted to the NICU. 

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the WHO ICTRP and trials registries. There were no restrictions to date, language or publication type. We also checked the reference lists of studies identified for full-text review. 

Selection criteria: 

Types of studies: cluster-randomized or quasi-randomized trials at the level of the cluster (where clusters may be defined by NICU, hospital, ward, or other subunits of the hospital). We also included cross-over trials with a washout period of more than four months (arbitrarily defined).

Types of participants: newborn infants less than six months of age in neonatal units that implemented patient isolation or cohorting as infection control measures to prevent HAIs.

Types of interventions: patient isolation measures (single-room isolation or cohorting, or both of infants with similar colonization or infections) compared to routine isolation measures.

Types of outcome measures: the primary outcome was the rate of transmission of HAIs as estimated by the infection and colonization rates in the NICU. Secondary outcomes included all-cause mortality during hospital stay at 28 days of age, length of hospital stay, as well as potential adverse effects of isolation or cohorting measures, or both.

Data collection and analysis: 

The standard methods of Cochrane Neonatal were used to identify studies and assess the methodological quality of eligible cluster-randomized trials. The certainty of the evidence was to be assessed by the GRADE method as evidence of high, moderate, low, or very low certainty. Infection and colonization rates were to be expressed as rate ratios for each trial and if appropriate for meta-analysis, the generic inverse variance method in RevMan was to be used.

Main results: 

We did not identify any published or ongoing trials to include in the review.