Time for a Neonatal-Specific Consensus Definition for Sepsis

Abstract

Objective To review the accuracy of the pediatric consensus definition of sepsis in term neonates and to determine the definition of neonatal sepsis used. Study selection The review focused primarily on pediatric literature relevant to the topic of interest. Conclusions Neonatal sepsis is variably defined based on a number of clinical and laboratory criteria that make the study of this common and devastating condition very difficult. Diagnostic challenges and uncertain disease epidemiology necessarily result from a variable definition of disease. In 2005, intensivists caring for children recognized that as new drugs became available, children would be increasingly studied and thus, pediatric-specific consensus definitions were needed. Pediatric sepsis criteria are not accurate for term neonates and have not been examined in preterm neonates for whom the developmental stage influences aberrations associated with host immune response. Thus, specific consensus definitions for both term and preterm neonates are needed. Such definitions are critical for the interpretation of observational studies, future training of scientists and practitioners, and implementation of clinical trials in neonates.

Postnatal Age Is a Critical Determinant of the Neonatal Host Response to Sepsis

“…The definition of neonatal sepsis is variable and often does not incorporate the presence and progression of clinical signs in the setting of laboratory evidence of systemic inflammation consistent with sepsis (9). For example, the inclusion of preterm infants with a single blood culture positive for coagulase-negative Staphylococcus (CoNS) may be considered sepsis (33), which is outside of the accepted Centers for Disease Control and Prevention definition for CoNS infection (34).…”

“…Expression measurement of the entire genome would not be required once a suitable set of predictive genes (<100) is identified. The identification of molecular endotypes that identify classes of infants via modern multiplex messenger RNA (mRNA) quantification platforms can be obtained rapidly (8)(9)(10)(11)(12) h) (38,39). Integration of these techniques into intensive care environments has great potential to benefit patient populations with diverse clinical presentations of infection such as preterm neonates.…”

“…These necessary interventions increase the risk of late-onset sepsis (≥3 d after birth and up to 120 d [8]). Lastly, the use of multiple definitions for sepsis in neonates severely limits the ability to build on experimental findings between research groups and hinders progress toward an improved understanding of the pathophysiology (9). Molecular endotyping can be successfully leveraged to identify diagnostic and prognostic gene signatures, identify novel therapeutic targets, uncover mechanisms behind differential sepsis outcomes, and reveal rapid and dynamic shifts in transcription patterns associated with various phases of sepsis (10).…”

A correlação entre procedimentos assistenciais invasivos e a ocorrência de sepse neonatal

“…(1,(5)(6)(7)(8) Neonatal sepsis is defined as a systemic response to infection, characterized by a clinical syndrome with different manifestations. (9,10) It can be classified as early (probably of maternal origin with symptoms in the first 48 hours of life) and late (probably of hospital origin). (9) Its presence is diagnosed through at least one of the following symptoms: 1) Apnea, bradypnea, whimpering, tachypnea, sternal and subcostal retractions, vacillation of nose wings and cyanosis; 2) Thermal instability (hypothermia <36.5º and hyperthermia >37.5º); 3) Hypotonia and convulsions; 4) Irritability and hypoactivity/lethargy; 5) Gastrointestinal symptoms, such as abdominal distension, vomiting, gastric residue and difficulty to accept food; 6) Idiopathic jaundice; 7) Cutaneous pallor, cold, sweaty skin, hypotension and capillary filling time of more than three seconds; 8) Glucose intolerance; 9) Signs of bleeding with condition suggesting disseminated intravascular coagulation; 10) Subjective assessment: Infant who "does not look well".…”

A Practical Approach to Emergencies in the Neonatal Period

“…Neonatal sepsis is a cause of high mortality and morbidity even if the antibiotic was administered correctly [12]. It is divided in early onset sepsis (EOS) that is present in the first week of life and late onset sepsis (LOS) from day 7 to 28 days of life.…”