Management of Neonates Born at ≤34 6/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

Abstract

Early-onset sepsis (EOS) remains a serious and often fatal illness among infants born preterm, particularly among newborn infants of the lowest gestational age. Currently, most preterm infants with very low birth weight are treated empirically with antibiotics for risk of EOS, often for prolonged periods, in the absence of a culture-confirmed infection. Retrospective studies have revealed that antibiotic exposures after birth are associated with multiple subsequent poor outcomes among preterm infants, making the risk/benefit balance of these antibiotic treatments uncertain. Gestational age is the strongest single predictor of EOS, and the majority of preterm births occur in the setting of other factors associated with risk of EOS, making it difficult to apply risk stratification strategies to preterm infants. Laboratory tests alone have a poor predictive value in preterm EOS. Delivery characteristics of extremely preterm infants present an opportunity to identify those with a lower risk of EOS and may inform decisions to initiate or extend antibiotic therapies. Our purpose for this clinical report is to provide a summary of the current epidemiology of preterm neonatal sepsis and provide guidance for the development of evidence-based approaches to sepsis risk assessment among preterm newborn infants.

Pathogens Responsible for Early-Onset Sepsis in Suzhou, China

“…EOS, specifically Gram-negative sepsis, is an important cause of neonatal death. E. coli has been found to be associated with most EOS deaths, primarily because of its predominance among very low birth weight infants (10,12,13 (10). In our study, we also found E. coli to be the most common pathogen associated with sepsis deaths (16 306, 5.2 ).…”

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment: a randomized trial of preterm infants

“…Symptoms of prematurity are difficult to discern from symptoms of infection which, compounded by the increased risk of infection, have led to most premature infants being exposed to antibiotics early in life 5–7 . Despite high mortality rates, the incidence of culture positive early onset sepsis (EOS) is relatively low, between 0.2-0.6% 8 . In the absence of a positive culture, a majority of preterm infants receive antibiotics immediately after birth based on maternal risk factors (e.g.…”

“…intra-amniotic infection) or laboratory abnormalities (e.g. elevated serum C-reactive protein (CRP) because of the risk of mortality 8 . Given the low incidence of culture positive EOS in this population, it is possible that such high rates of antibiotic use are unnecessary and may increase morbidity in these infants 9 .…”

Markers of NETosis Do Not Predict Neonatal Early Onset Sepsis: A Pilot Study

“…Neonatal sepsis is a common disorder and is associated with high morbidity and mortality while being particularly difficult to predict and thus treat appropriately (2,22). It has been reported that markers of NET formation, such as cfDNA, are excellent biomarkers of sepsis in adult polytrauma patients (20).…”