Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

Johnson, Carrie; Whitwell, Judy K.; Pethe, Kalpana; Saxena, Kapil; Super, Dennis M.

doi:10.1542/peds.99.4.e10

Cited by 68 publications

(39 citation statements)

References 14 publications

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“…The typical complete sepsis workup in a neonate consists of obtaining a complete white blood cell count with differential, a single blood culture, urine cultures, and a lumbar puncture for cell count and culture (28,111). In addition, there may be a role for culture and Gram staining of tracheal aspirates in intubated neonates shortly after birth.…”

Section: Laboratory Findings and Diagnosticsmentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

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Section: Laboratory Findings and Diagnosticsmentioning

confidence: 99%

Early-Onset Neonatal Sepsis

et al. 2014

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“…In the high-risk, healthy-appearing infant, data suggest that the likelihood of meningitis is extremely low. 38 In the infant with clinical signs that are thought to be attributable to a noninfectious condition, such as respiratory distress syndrome, the likelihood of meningitis is also low. 39 However, in bacteremic infants, the incidence of meningitis may be as high as 23%.…”

Section: Lumbar Puncturementioning

confidence: 99%

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Polin¹,

Newborn²

2012

Pediatrics

683

433

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With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis. Pediatrics

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“…9,10 In addition, neither make an assessment of how many infants actually should be or would be evaluated or treated. 9,11 Concern for EOS results in the evaluation and empirical antibiotic treatment of hundreds of thousands of uninfected newborns annually, [12][13][14][15] resulting in maternal/infant separation and significant expenditures. For example, EOS evaluations based on the CDC 2002 guidelines 11 resulted in the evaluation of 15% of all well-appearing infants born at $35 weeks' gestation at 1 of our centers.…”

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confidence: 99%

Stratification of Risk of Early-Onset Sepsis in Newborns ≥34 Weeks’ Gestation

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:The management of term and near-term newborns suspected of early-onset sepsis, particularly when they are not clearly symptomatic, remains controversial. Methods for quantifying risk that combine maternal factors with a newborn' s evolving clinical examination have been lacking. WHAT THIS STUDY ADDS:This study provides a method for predicting risk of early-onset sepsis. It combines maternal risk factors with objective measures of a newborn' s clinical examination and places newborns into 3 risk groups (treat empirically, observe and evaluate, and continued observation). abstract OBJECTIVE: To define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns $34 weeks' gestation. METHODS:We conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth. Using a combination of recursive partitioning and logistic regression, we developed a risk classification scheme for EOS on the derivation dataset. This scheme was then applied to the validation dataset.

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Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?

Cited by 68 publications

References 14 publications

Early-Onset Neonatal Sepsis

Early-Onset Neonatal Sepsis

Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis

Stratification of Risk of Early-Onset Sepsis in Newborns ≥34 Weeks’ Gestation

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