Umbilical cord blood culture in neonatal early-onset sepsis: a systematic review and meta-analysis

Dierikx, Thomas H.; Kaam, A.H.L.C. van; Meij, Tim G. J. de; Vries, Ralph de; Onland, Wes; Visser, Douwe H.

doi:10.1038/s41390-021-01792-0

Cited by 11 publications

(5 citation statements)

References 44 publications

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“…A notable limitation is that the source of the blood was not tracked during our study. Although Diericks et al [12] argued that "umbilical cord blood culture has higher sensitivity and comparable specificity for the diagnosis of neonatal early-onset sepsis", such findings might not be directly applicable to this low-risk EONS group.…”

Section: Discussionmentioning

confidence: 95%

“…The inoculation of at least 1 mL of venous blood for a blood culture would increase the sensitivity of pathogen detection but is rarely achieved in premature infants. Use of umbilical cord blood may be useful to ensure adequate blood volumes and can avoid skin punctures otherwise not indicated in the newborn but may be prone to contamination [10][11][12]. Moreover, the protracted 36-48 h waiting period for results, coupled with its diminished sensitivity and specificity in EONS, renders it less ideal [7].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Multiplex Polymerase Chain Reaction in Early Onset Neonatal Sepsis

Stein,

Soukup,

Rath

et al. 2023

Children

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Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex PCR test. Newborns at risk of neonatal sepsis were prospectively screened as recommended per national guidelines. Evaluations included laboratory parameters (CrP, IL6, differential blood count), blood culture, and a molecular multiplex PCR test (ROCHE LightCycler SeptiFast®) identifying 20 common microbial agents. Blood samples were taken simultaneously from umbilical cord or venous sources on the first day of life. Of 229 infants included, 69% were born preterm. Blood culture and multiplex PCR sensitivity were 7.4% and 14.8%, respectively. Specificity, negative and positive predictive values between methods showed no significant variance, although multiplex PCR had more false positives due to contamination. The limited sensitivity of blood cultures for early onset neonatal sepsis is concerning. Despite quicker results, multiplex PCR does not enhance diagnostic accuracy or antibiotic therapy guidance, thus it cannot be recommended for this indication.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Multiplex Polymerase Chain Reaction in Early Onset Neonatal Sepsis

Stein,

Soukup,

Rath

et al. 2023

Children

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“…A limited volume is often sampled due to the risk of iatrogenic anemia in infants [26][27][28], but this may increase the risk for false negative results. Collection of blood from the umbilical cord allows sampling of a larger volume, which increases the sensitivity of a blood culture [29]. Previous standard operating manuals have been designed for sterile collection of cord blood [19].…”

Section: Discussionmentioning

confidence: 99%

Potential of Molecular Culture in Early Onset Neonatal Sepsis Diagnosis: A Proof of Principle Study

Dierikx

Budding²,

Bos³

et al. 2023

Microorganisms

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Delay in the time-to-positivity of a peripheral blood culture (PBC), the gold standard for early onset neonatal sepsis (EOS) diagnosis, has resulted in excessive use of antibiotics. In this study, we evaluate the potential of the rapid Molecular Culture (MC) assay for quick EOS diagnosis. In the first part of this study, known positive and spiked blood samples were used to assess the performance of MC. In the in vivo clinical study, the second part of this study, all infants receiving antibiotics for suspicion of EOS were included. At initial EOS suspicion, a blood sample was collected for PBC and MC. MC was able to detect bacteria present in the spiked samples even when the bacterial load was low. In the clinical study, MC was positive in one infant with clinical EOS (Enterococcus faecalis) that was not detected by PBC. Additionally, MC was positive in two infants without clinical sepsis (Streptococcus mitis and multiple species), referred to as contamination. The other 37 samples were negative both by MC and PBC. MC seems to be able to detect bacteria even when the bacterial load is low. The majority of MC and PBC results were comparable and the risk for contamination and false positive MC results seems to be limited. Since MC can generate results within 4 h following sampling compared with 36–72 h in PBC, MC may have the potential to replace conventional PBC in EOS diagnostics in order to guide clinicians on when to discontinue antibiotic therapy several hours after birth.

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“…Peripheral blood culture remains the gold standard for the diagnosis of sepsis. Recent studies have evaluated umbilical cord blood culture as a possible tool for EOS diagnosis, even though this is still not validated [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

et al. 2022

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Current neonatal early-onset sepsis (EOS) guidelines lack consensus. Recent studies suggest three different options for EOS risk assessment among infants born ≥35 wks gestational age (GA), leading to different behaviors in the sepsis workup and antibiotic administration. A broad disparity in clinical practice is found in Neonatal Units, with a large number of non-infected newborns evaluated and treated for EOS. Broad spectrum antibiotics in early life may induce different short- and long-term adverse effects, longer hospitalization, and early mother-child separation. In this single-center prospective study, a total of 3002 neonates born in three periods between 2016 and 2020 were studied, and three different workup algorithms were compared: the first one was based on the categorical risk assessment; the second one was based on a Serial Physical Examination (SPE) strategy for infants with EOS risk factors; the third one associated an informatic tool (Neonatal EOS calculator) with a universal extension of the SPE strategy. The main objective of this study was to reduce the number of neonatal sepsis workups and the rate of antibiotic administration and favor rooming-in and mother–infant bonding without increasing the risk of sepsis and mortality. The combined strategy of universal SPE with the EOS Calculator showed a significant reduction of laboratory tests (from 33% to 6.6%; p < 0.01) and antibiotic treatments (from 8.5% to 1.4%; p < 0.01) in term and near-term newborns. EOS and mortality did not change significantly during the study period.

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Umbilical cord blood culture in neonatal early-onset sepsis: a systematic review and meta-analysis

Cited by 11 publications

References 44 publications

Diagnostic Accuracy of Multiplex Polymerase Chain Reaction in Early Onset Neonatal Sepsis

Diagnostic Accuracy of Multiplex Polymerase Chain Reaction in Early Onset Neonatal Sepsis

Potential of Molecular Culture in Early Onset Neonatal Sepsis Diagnosis: A Proof of Principle Study

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

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