A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis

@article{Kuzniewicz2017AQR,
  title={A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis},
  author={Michael W Kuzniewicz and Karen M Puopolo and Allen Fischer and Eileen M. Walsh and Sherian Xu Li and Thomas B. Newman and Patricia Kipnis and Gabriel J. Escobar},
  journal={JAMA Pediatrics},
  year={2017},
  volume={171},
  pages={365–371}
}
Importance Current algorithms for management of neonatal early-onset sepsis (EOS) result in medical intervention for large numbers of uninfected infants. We developed multivariable prediction models for estimating the risk of EOS among late preterm and term infants based on objective data available at birth and the newborn’s clinical status. Objectives To examine the effect of neonatal EOS risk prediction models on sepsis evaluations and antibiotic use and assess their safety in a large… 

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References

SHOWING 1-10 OF 44 REFERENCES
Stratification of Risk of Early-Onset Sepsis in Newborns ≥34 Weeks’ Gestation
TLDR
It is possible to combine objective maternal data with evolving objective neonatal clinical findings to define more efficient strategies for the evaluation and treatment of EOS in term and late preterm infants.
Estimating the Probability of Neonatal Early-Onset Infection on the Basis of Maternal Risk Factors
TLDR
A quantitative model is developed that establishes a prior probability for newborn sepsis, which could be combined with neonatal physical examination and laboratory values to establish a posterior probability to guide treatment decisions.
The Burden of Invasive Early-onset Neonatal Sepsis in the United States, 2005–2008
TLDR
The burden of invasive EOS remains substantial in the era of GBS prevention and disproportionately affects preterm and black infants and Identification of strategies to prevent preterm births is needed to reduce the neonatal sepsis burden.
Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines
TLDR
Improved approaches are needed to identify asymptomatic infants who are at risk for EOS to decrease unnecessary evaluations and antibiotic exposure and transition to the 2010 CDC GBS guidelines may eliminate a quarter of EOS evaluations among these infants.
2010 Perinatal GBS Prevention Guideline and Resource Utilization
TLDR
Implementation of an EOS algorithm based on CDC 2010 GBS guidelines resulted in a 25% decrease in EOS evaluations performed among well-appearing infants ≥36 weeks’ gestation, attributable to decreased evaluation of infants born in the setting of inadequate indicated GBS prophylaxis, which resulted in significant changes in Eos evaluation-associated resource expenditures.
No Change in the Incidence of Ampicillin-Resistant, Neonatal, Early-Onset Sepsis Over 18 Years
TLDR
Overall peripartum antibiotic use increased during the study period primarily because of increased use of penicillin G and clindamycin, with no significant change in the use of ampicillin.
Application of sepsis calculator in newborns with suspected infection
  • M. Kerste, J. Corver, F. Plötz
  • Medicine
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
  • 2016
Abstract Objective: To compare actual antibiotic use to the stratification based on the sepsis calculator in newborns with suspected early onset sepsis (EOS). To investigate differences in EOS risk
Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues
TLDR
In the era of intrapartum chemoprophylaxis to reduce GBS, rates of EO infection have declined but reflect a continued burden of disease, suggesting that Escherichia coli is an important EO pathogen.
Association of antibiotics in infancy with early childhood obesity.
TLDR
Repeated exposure to broad-spectrum antibiotics at ages 0 to 23 months is associated with early childhood obesity, and narrowing antibiotic selection is potentially a modifiable risk factor for childhood obesity.
...
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