Stratification of Risk of Early-Onset Sepsis in Newborns ≥34 Weeks’ Gestation

  title={Stratification of Risk of Early-Onset Sepsis in Newborns ≥34 Weeks’ Gestation},
  author={Gabriel J. Escobar and Karen M Puopolo and Soora Wi and Benjamin J. Turk and Michael W Kuzniewicz and Eileen M. Walsh and Thomas B. Newman and John A. F. Zupancic and Ellice S. Lieberman and David Draper},
  pages={30 - 36}
OBJECTIVE To define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ≥ 34 weeks' gestation. [] Key MethodMETHODS We conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth.
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.
Use of Early-Onset Sepsis Risk Calculator for Neonates ≥ 34 Weeks in a Large Tertiary Neonatal Centre, Saudi Arabia
Early-onset sepsis (EOS) refers to sepsis with onset before 72 hours of life. Kaiser Permanente Calculator (KPC) or EOS risk calculator is an advanced multivariate risk model for predicting EOS in
Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines
An evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator and some missed cases of culture-positive EOS have also been described.
Delivery Characteristics and the Risk of Early-Onset Neonatal Sepsis.
Risk of EOS among infants with low-risk delivery characteristics is extremely low, and a substantial proportion of these infants are administered antibiotics, which should inform empirical antibiotic management decisions among infants born at all gestational ages.
Early-onset Sepsis and Antibiotic Exposure in Term Infants: A Nationwide Population-based Study in Norway
In this registry-based study, the incidence of culture-confirmed EOS was in line with previous international reports and the mortality was very low and a large proportion of infants without infection were treated with antibiotics.
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.
Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis
The purpose in this clinical report is to provide a summary of the current epidemiology of neonatal sepsis among infants born at ≥35 0/7 weeks’ gestation and a framework for the development of evidence-based approaches to sepsi risk assessment among these infants.
Implementation of the Neonatal Sepsis Calculator in an Australian Tertiary Perinatal Centre
Application of this clinical decision support tool may reduce the number of infants undergoing investigations and empirical treatment for suspected sepsis, as well as the cost to the NHS.
Predictors of early-onset neonatal sepsis or death among newborns born at <32 weeks of gestation
Earlier gestational age at the time of delivery, intrapartum fever, meconium, and lower birth weight are independently associated with early-onset neonatal sepsis or death among deliveries occurring at <32 weeks of gestation; these factors can be used to create a model with fair predictive capability.


Estimating the Probability of Neonatal Early-Onset Infection on the Basis of Maternal Risk Factors
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.
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.
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.
The Burden of Invasive Early-onset Neonatal Sepsis in the United States, 2005–2008
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.
Risk Factors and Opportunities for Prevention of Early-Onset Neonatal Sepsis: A Multicenter Case-Control Study
Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases, but the severity of ampicillin-resistant E coli sepsis and its occurrence after maternal antibiotics suggest caution regarding use ofAmpicillin instead of penicillin for GBS prophylaxis.
No Change in the Incidence of Ampicillin-Resistant, Neonatal, Early-Onset Sepsis Over 18 Years
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.
Interpreting Complete Blood Counts Soon After Birth in Newborns at Risk for Sepsis
Optimal interpretation of the CBC requires using interval likelihood ratios for the newborn's age in hours, especially for WBC counts and ANCs, which improved with age in the first few hours.
Early and late onset sepsis in late preterm infants
Preterm birth is increasing worldwide. Late preterm infants (from 34+0 to 36+6 weeks of gestation) comprise more than 70% of premature infants and this percentage has been increasing in recent years.
Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis
The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis.
Seventy-Five Years of Neonatal Sepsis at Yale: 1928–2003
The demographics, pathogens, and outcome associated with neonatal sepsis continue to change, and a marked increase in cases as a result of commensal species was observed in preterm infants who had indwelling central vascular catheters, were receiving parenteral nutrition, and required prolonged mechanical ventilation.