Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

  title={Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis},
  author={Karen M Puopolo and William E. Benitz and Theoklis Zaoutis},
The incidence of neonatal early-onset sepsis (EOS) has declined substantially over the last 2 decades, primarily because of the implementation of evidence-based intrapartum antimicrobial therapy. However, EOS remains a serious and potentially fatal illness. Laboratory tests alone are neither sensitive nor specific enough to guide EOS management decisions. Maternal and infant clinical characteristics can help identify newborn infants who are at risk and guide the administration of empirical… 
Management of Late-Preterm and Term Neonates at Risk for Early-Onset Sepsis.
There was significant overtreatment of infants as well as much interinstitutional and interclinician variation in the frequency of antibiotic use for neonates at risk for EOS.
Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies.
The rate of E coli infection increased among very low-birth-weight infants and associated mortality disproportionately occurred in preterm infants, and ongoing surveillance should monitor antibiotic susceptibilities of EOS pathogens.
New Approaches to the Evaluation and Management of Well-Appearing Term and Late Preterm Neonates at Risk for Early-Onset Sepsis
The Neonatal Early-Onset Sepsis Calculator is a useful tool that quantifies an individual newborn’s EOS risk based on perinatal risk factors and clinical examination and has been shown to decrease laboratory evaluations and antibiotic use.
Brief comments on three existing approaches for managing neonates at risk of early-onset sepsis
There is a need to assess which symptoms at birth are more predictive of EOS, and therefore require immediate interventions, or symptoms that can be carefully reevaluated without necessarily treat immediately the neonate with antibiotics.
Serial clinical observation for management of newborns at risk of early-onset sepsis.
SCO strategy may require changes in the processes of newborn care at birthing centers, Nonetheless, SCO is safe and is associated with fewer laboratory evaluations and unnecessary antibiotics.
Neonatal Early Onset Sepsis: Impact of Kaiser Calculator in an Italian Tertiary Perinatal Center
Application of the EOS calculator more than halved the burden of intensive monitoring and antibiotic exposure, without compromising safety in a population with a relatively low incidence of culture-proven EOS and good access to follow-up care.
Antibiotic stewardship for early-onset sepsis.
Management of Infants at Risk for Group B Streptococcal Disease
The American Academy of Pediatrics joins with the American College of Obstetricians and Gynecologists to reaffirm the use of universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of intrapartum antibiotic prophylaxis.
Can a neonatal sepsis risk calculator safely decrease unnecessary evaluation for neonatal sepsis and the number of newborns exposed to antibiotics?
Several cohort studies have demonstrated that the Kaiser Permanente Neonatal Early-Onset Sepsis Calculator for term/late preterm newborns can decrease the number of babies receiving evaluation and/or treatment for EOS without increasing the incidence of adverse outcomes.


Early-onset sepsis: a predictive model based on maternal risk factors
An alternative approach to EOS risk assessment based only on objective data could decrease the number of infants evaluated and empirically treated for EOS, compared with currently recommended algorithms.
Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines
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.
Risk assessment in neonatal early onset sepsis.
The development of multivariate predictive models may provide more accurate methods of identifying newborns at highest risk and allow for more limited newborn antibiotic exposures.
A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis
Clinical care algorithms based on individual infant estimates of EOS risk derived from a multivariable risk prediction model reduced the proportion of newborns undergoing laboratory testing and receiving empirical antibiotic treatment without apparent adverse effects.
Neonatal Sepsis Workups in Infants ≥2000 Grams at Birth: A Population-Based Study
The risk of bacterial infection in asymptomatic newborns is low and evidence-based observation and treatment protocols could be defined based on a limited set of predictors: maternal fever, chorioamnionitis, initial neonatal examination, and absolute neutrophil count.
Effect of early-onset sepsis evaluations on in-hospital breastfeeding practices among asymptomatic term neonates.
Early separation of asymptomatic infants from their mothers for EOS evaluation was significantly associated with delayed initiation of breastfeeding, which in turn was associated with increased formula supplementation in the first day of life.
Perinatal antibiotic exposure of neonates in Canada and associated risk factors: a population-based study
  • R. R. Persaud, M. Azad, R. Chari, M. Sears, A. Becker, A. Kozyrskyj
  • 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
  • 2015
Overweight women and women with hypertension were significantly more likely to receive intrapartum antibiotics for caesarean section or GBS prophylaxis, and neonates in Canada are routinely exposed to antibiotics during the perinatal period.
Epidemiology of Invasive Early-Onset Neonatal Sepsis, 2005 to 2014
GBS prevention efforts have not led to an increasing burden of early-onset E coli infections, however, the stable burden of E coli sepsis and associated mortality underscore the need for interventions.
Stratification of Risk of Early-Onset Sepsis in Newborns ≥34 Weeks’ Gestation
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.
Implementation of the Sepsis Risk Calculator at an Academic Birth Hospital.
The SRC was integrated into the workflow of a large, academic perinatal center, resulting in significant reductions in antibiotics and laboratory testing for EOS and demonstrating the potential for this approach to impact national practice.