Variation in Current Management of Term and Late-preterm Neonates at Risk for Early-onset Sepsis

Abstract

There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

Neonatal Sepsis

“…Recommendations from the Canadian Pediatric Society (CPS) and the AAP recommend initiating antibiotic therapy if clinical symptoms are present, with the AAP also recommending antibiotics in the presence of abnormal laboratory values or more than one risk factor ( Table 2) [48]. The presence of maternal chorioamnionitis with no neonatal clinical signs warrants antibiotic initiation as per the AAP and only if present with laboratory abnormalities per the CPS.…”

“…The presence of maternal chorioamnionitis with no neonatal clinical signs warrants antibiotic initiation as per the AAP and only if present with laboratory abnormalities per the CPS. The US Center for Disease Control and Prevention (CDC) recommends empiric antibiotic therapy for all newborns with a maternal diagnosis of chorioamnionitis, regardless of the infant's clinical condition [48,49]. Reevaluation at 48 hours and discontinuation of antibiotics if infection was unlikely was universally recommended [48].…”

Early-Life Host–Microbiome Interphase: The Key Frontier for Immune Development

“…Clinical diagnosis of EOS is imprecise and based on non-specific signs and symptoms; rapid, sensitive tests to differentiate infected from uninfected newborns are also lacking (105). Therefore, EAT is administered to a very large number of newborns (106, 107). While this empiric approach can readily be justified given the potentially horrific outcome of treatment delay in EOS (105), the impact on the microbiome, immune development, and clinical outcome beyond sepsis has barely been investigated.…”

There is an urgent need for evidence-based internationally agreed guidelines for the assessment of neonates at risk of developing early-onset sepsis

“…Ambiguities in the definition of specific risk factors and poor test performance of common screening laboratory test may lead to challenges and controversies in clinical implementation. Guidelines internationally have been shown to differ considerably regarding the decision to start antibiotics in low-risk neonates and also regarding the length of treatment needed to treat high-risk infants 4. A recent UK study highlighted the logistical challenge for implementing the National Institute for Health and Care Excellence (NICE) guidelines (2012) as only 47.5% of the microbiology laboratories were reporting negative blood culture results through an automated system including out-of-hours—this can increase duration of antibiotics, over-reliance on laboratory tests (C-reactive protein) and prolonging hospital stay in otherwise well neonates 5…”