The Conundrum of Early-Onset Sepsis

Polin, Richard A.; Watterberg, Kristi L.; Benitz, William Ε.; Eichenwald, Eric

doi:10.1542/peds.2014-0360

Cited by 53 publications

(42 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, the frequency of congenital microbial invasion of the fetus is likely to be higher than that reported in the pediatric literature – the reasons for this are multiple (e.g. bacteremia may not be continuous in the neonatal period; the inoculum size may be small, leading to a high rate of negative blood cultures; and the lack of detection of the most common microorganisms, genital mycoplasmas, may reflect that cultures for these organisms require special media, and such cultures are not routinely performed in neonatal intensive care units) 330-332 .…”

Section: The Fetal Inflammatory Response Syndrome (Firs)mentioning

confidence: 98%

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

728

652

View full text Add to dashboard Cite

Acute inflammatory lesions of the placenta consist of diffuse infiltration of neutrophils at different sites in the organ. These lesions include acute chorioamnionitis, funisitis, and chorionic vasculitis, and represent a host response (maternal or fetal) to a chemotactic gradient in the amniotic cavity. While acute chorioamnionitis is evidence of a maternal host response, funisitis and chorionic vasculitis represent fetal inflammatory responses. Intra-amniotic infection has been generally considered to be the cause of acute histologic chorioamnionitis and funisitis; however, recent evidence indicates that “sterile” intra-amniotic inflammation, which occurs in the absence of demonstrable microorganisms but can be induced by “danger signals”, is frequently associated with these lesions. In the context of intra-amniotic infection, chemokines (such as interleukin-8 and granulocyte chemotactic protein) establish a gradient favoring the migration of neutrophils from maternal or fetal circulation into the chorioamniotic membranes or umbilical cord, respectively. Danger signals released during the course of cellular stress or cell death can also induce the release of neutrophil chemokines. The prevalence of chorioamnionitis is a function of gestational age at birth, and is present in 3-5% of placentas delivered at term, but in 94% of placentas delivered between 21-24 weeks of gestation. The frequency is higher in patients with spontaneous labor, preterm labor, clinical chorioamnionitis (preterm or term), or ruptured membranes. Funisitis and chorionic vasculitis are the hallmarks for the fetal inflammatory response syndrome, a condition characterized by an elevation in fetal plasma concentrations of interleukin-6, associated with the impending onset of preterm labor, a higher rate of neonatal morbidity (after adjustment for gestational age), and multi-organ fetal involvement. This syndrome is the counterpart of the systemic inflammatory response syndrome in adults; however, in fetuses, it is a risk factor for short- and long-term complications (i.e. neonatal sepsis, bronchopulmonary dysplasia, periventricular leukomalacia, and cerebral palsy). This article reviews the definition, pathogenesis, grading and staging, and clinical significance of the most common lesions in placental pathology. Illustrations of the lesions and diagrams of the mechanisms of disease are provided.

show abstract

Section: The Fetal Inflammatory Response Syndrome (Firs)mentioning

confidence: 98%

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

728

652

View full text Add to dashboard Cite

show abstract

“…It had been considered good practice to screen babies who present with early respiratory distress for infection; however, it is now known that routine antibiotic prophylaxis has the potential to do more harm than good [141,142,143]. Guidelines usually offer advice on when to screen for sepsis based on additional risk factors such as maternal chorio-amnionitis or early signs of septicaemia in the hope that antibiotics are only prescribed for those at greatest risk [144].…”

Section: Monitoring and Supportive Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

View full text Add to dashboard Cite

Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

show abstract

“…[99] Among the key recommendations which could limit antibiotic use and is concordant with the latest recommendation by members of the AAP Committee on Fetus and Newborn, is that isolated abnormal hematological or acute-phase-reactant measurements should not justify continuation of empiric antibiotics for more than 48 hours in well-appearing infants with negative culture results. [99, 100] We await similar evidence to support guidance for late onset sepsis in NICUs.…”

Section: Antibiotic Practice Modifications/stewardship Effortsmentioning

confidence: 99%

Adverse consequences of neonatal antibiotic exposure

Cotten

2016

Current Opinion in Pediatrics

130

121

View full text Add to dashboard Cite

Purpose of the review Antibiotics have saved lives and improved outcomes, but they also influence the evolving microbiome. This review 1) summarizes reports on neonatal infections and variation in antibiotic utilization, 2) discusses the emergence of resistant organisms, and 3) presents data from human neonates and animal models demonstrating impact of antibiotics on the microbiome, and how microbiome alterations impact health. The importance of antibiotic stewardship is also discussed. Recent findings Infections increase neonatal morbidity and mortality. Furthermore, the clinical presentation of infections can be subtle, prompting clinicians to empirically start antibiotics when infection is a possibility. Antibiotic-resistant infections are a growing problem. Cohort studies have identified extensive center variations in antibiotic usage and associations between antibiotic exposures and outcomes. Studies of antibiotic-induced microbiome alterations and downstream effects on the developing immune system have increased our understanding of the mechanisms underlying the associations between antibiotics and adverse outcomes. The emergence of resistant microorganisms and recent evidence linking antibiotic practice variations with health outcomes has led to initiation of antibiotic stewardship programs. Summary This review encourages practitioners to assess local antibiotic use with regard to local microbiology, and to adopt steps to reduce infections and use antibiotics wisely.

show abstract

The Conundrum of Early-Onset Sepsis

Cited by 53 publications

References 10 publications

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

Adverse consequences of neonatal antibiotic exposure

Contact Info

Product

Resources

About