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

@article{Puopolo2018ManagementON,
  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},
  journal={Pediatrics},
  year={2018},
  volume={142}
}
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.
TLDR
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.
TLDR
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
TLDR
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
TLDR
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.
TLDR
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
TLDR
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
TLDR
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?
TLDR
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.
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