Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use

Herk, Wendy van; Stocker, Martin; Rossum, Annemarie M. C. van

doi:10.1016/j.jinf.2016.04.026

Cited by 62 publications

(51 citation statements)

References 53 publications

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“…Serial daily blood cultures should be performed until blood cultures are negative. Serial CRP measurements may also be used in deciding to discontinue antibiotics [56,57]. An infant with symptoms can have a false-negative blood culture if antibiotics are given prenatally to the mother or if the blood sample is collected improperly.…”

Section: Proven Bacterial Sepsis Without Meningitismentioning

confidence: 99%

Neonatal Sepsis

Ershad

Mostafa

Cruz

et al. 2019

Curr Emerg Hosp Med Rep

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Section: Proven Bacterial Sepsis Without Meningitismentioning

confidence: 99%

Neonatal Sepsis

Ershad

Mostafa

Cruz

et al. 2019

Curr Emerg Hosp Med Rep

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“…2 For infants born at >34 weeks gestational age (GA), the incidence of EOS is 0.3-0.8/1,000 live births. 3,4 Lower GA dramatically increases the risk for perinatal infection, as 4.8%-16.9% of preterm infants exposed to chorioamnionitis go on to develop culture-positive EOS, in contrast to only 0.47%-1.24% of similarly exposed infants born at ≥35 weeks GA. 3,5 LOS has been shown to be associated with increased risk of bronchopulmonary dysplasia and neurological morbidities. 6,7 The challenge of diagnosing NS is that both EOS and LOS often present with aspecific clinical signs that show significant overlap with common uninfectious conditions, such as transitional tachypnea and apnea of prematurity.…”

Section: Introductionmentioning

confidence: 99%

<p>Neonatal sepsis biomarkers: where are we now?</p>

Gilfillan¹,

Bhandari²

2019

RRN

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Given that neonatal sepsis remains an important factor contributing to mortality and morbidity in neonates, identification of accurate biomarkers to aid in its timely and accurate diagnosis is critical. In this review, we discuss the current evidence behind the use of biomarkers commonly used in clinical practice, as well as presenting recent developments in this area of research. Besides summarizing information regarding "traditional" biomarkers (eg, hematological indices, CRP, and other acute-phase reactants, cytokines), we provide the latest clinical status on some relatively "newer" biomarkers (eg, PCR-and "-omic" technology-based, biophysical biomarkers) in the diagnosis of neonatal sepsis. We believe that certain biophysical (RALIS, core-peripheral temperature differences) in combination with selective biochemical (procalcitonin, nCD64, presepsin) markers offer the best likelihood of being adopted for clinical use in the detection of neonatal sepsis in the near future. In addition, serial measurements of selective biochemical markers (procalcitonin, nCD64) offer promise in the decision to initiate and/or control the duration of antibiotic therapy. It is important to conduct adequately powered prospective multicenter studies to continue to establish the accuracy and safety of utilizing such biomarkers of neonatal sepsis so that appropriate and adequate therapy is tailored to each infant for optimal outcomes.

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“…The nal model found that patients with lethargy and tachypnoea had higher odds for adherence to WHO guidelines. A plausible explanation could be that when physicians encounter a case that clinically presents as sepsis, they observe guidelines to a higher extent (12). Consequently, in more ambiguous cases, a broader second line treatment such as Cefotaxime is chosen.…”

Section: Discussionmentioning

confidence: 99%

“…WHO has listed symptoms that should be seen as red ags for neonatal sepsis; di cult to feed, lethargy, fast breathing, grunting, sub-costal recessions, fever, hypothermia and central cyanosis. All of those signs could however be present also without an infection, making the case de nition di cult (12).…”

Section: Introductionmentioning

confidence: 99%

Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

Ekman

Paudel²,

Basnet³

et al. 2020

Preprint

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Background Neonatal sepsis is one of the major causes of death during the first month of life and early empirical treatment with injectable antibiotics is a life-saving intervention. Adherence to World Health Organisation guidelines on first line antibiotics is crucial to mitigate the risks of increased antimicrobial resistance. The aim of this paper was to evaluate if treatment of early onset neonatal sepsis in a low-income facility setting observe current guidelines and if compliance is influenced by contextual factors. Methods This cohort study used data on antimicrobial treatment of neonatal sepsis onset within 72 hours of life from 12 regional hospitals participating in a scale-up trial of a neonatal resuscitation quality improvement package intervention in Nepal. Infants treated according to guidelines were compared with those receiving other antimicrobials. A multiple logistic regression analysis adjusted for the intervention and time trend was applied. Results 1,564 infants with a preliminary diagnosis of early onset sepsis were included. A majority (74.9%) were treated according to guidelines and adherence was increasing over time. Infants born at larger facilities (adjusted Odds Ratio 5.6), those that were inborn (adjusted Odds Ratio 1.97) or belonging to a family of dis-advantaged caste (adjusted Odds Ratio 2.15) had higher odds for treatment according to guidelines. A clinical presentation of lethargy or tachypnoea was associated with adherence to guidelines. Conclusion Adherence to guidelines for antibiotic treatment of early neonatal sepsis was moderately high in this low-income setting. Odds for observing guidelines increased with facility size, for inborn infants and if the family belonged to a dis-advantaged caste. Cefotaxime was a common alternative choice when guidelines were not followed, highly relevant for the risk of increased antimicrobial resistance.

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Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use

Cited by 62 publications

References 53 publications

Neonatal Sepsis

Neonatal Sepsis

<p>Neonatal sepsis biomarkers: where are we now?</p>

Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

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