Can Fullterm and Nearterm Infants at Risk for Sepsis be Managed Safely Without Antibiotics?

Chorioamnionitis and Management of Asymptomatic Infants ≥35 Weeks Without Empiric Antibiotics

“…Asymptomatic infants with ≥1 of 5 laboratory criteria (a WBC count of >30 000 mm −1 or <5000 mm −1 , band counts of >24%, hsCRP of >10 mg/L, and/or positive blood cultures) were transferred to the NICU, and antibiotic therapy was initiated. 18 The immature neutrophil to total neutrophil ratio was not used because our laboratory reports only band count range, and an accurate ratio cannot be calculated. Lumbar puncture was performed for clinical sepsis, a positive blood culture, or persistent laboratory abnormalities.…”

“…16,17 At LAC+USC Medical Center, it has been the guideline to complete a laboratory evaluation in asymptomatic newborn infants ≥35 weeks' gestation born to mothers with clinical chorioamnionitis without administration of empirical antibiotics. 18 The objective of this study was to evaluate clinical outcomes of asymptomatic chorioamnionitis-exposed late preterm and term infants by using our alternative guideline.…”

Group B Streptococcal Infections in Newborns

“…The white blood cell count tends to decline in the first 24 hours of life in the face of infection, and the ratio of immature to total neutrophils is usually elevated, greater than 0.2 (Baker & Edwards, 1995). Garner and Hodgman (1999) reported that the white count and differential may be unreliable in the first 24 hours of life and the immature to total neutrophil count may be falsely elevated. Both the blood culture and the CBC need to be evaluated in conjunction with the newborn's clinical status.…”

“…It is important to realize that this recommendation is empiric and is not based on randomized trials (AAP Committee on Infectious Diseases and Committee on Fetus and Newborn, 1997; Demianczuk, Halperin, & McMillan, 1997;Schuchat, 1998). Garner and Hodgman (1999) recommended repeating laboratory tests that are incon-clusive (I/T ratio greater than 0.12, band count greater than l o % , or C reactive protein between one and three) within 24 hours to see if they normalize.…”

“…The 48-hour observation period is based on the knowledge that almost 20% of early-onset GBS infections do not present until Day 2 of life (Schuchat, 1998). There have been no controlled studies that support the assumption that 48 hours is an acceptable length of observation (Garner & Hodgman, 1999;Schuchat, 1998). Peralta-Carcelen et al (1996) stated that it is unlikely there will ever be a randomized controlled trial to evaluate the AAP and CDC recommendations for full-term asymptomatic newborns whose mothers have received intrapartum chernoprophylaxis, mainly due to the sample size necessary.…”