Evaluation and Management of Newborns with Suspected Early-Onset Sepsis: Comparison of Two Approaches and Suggestion for Guidelines

Abstract

Objective Although its incidence is declining with the widespread use of intrapartum antibiotics, early-onset sepsis (EOS) continues to be associated with high morbidity and mortality. Maternal, infant, and peripartum risk factors, as well as infant's laboratory tests, have been used to try and identify asymptomatic newborns at risk. In this study, we reevaluate the management of newborns at risk for EOS by comparing our outcomes using two different approaches.

Study Design Comparison of clinical data and outcomes of newborns at risk for EOS between two study periods, in which we have used two different protocols for their evaluation and management.

Results Although outcomes were not different, adoption of the criteria suggested in the 2012 American Academy of Pediatrics guidelines in the second era resulted in increased utilization of diagnostic laboratory tests and increased use of empiric antibiotic treatments with less yield in a population with a low incidence of EOS (< 0.3/1,000 live births), such as ours.

Conclusion In asymptomatic newborns at risk for EOS, careful assessment of a set of maternal, infant, and peripartum risk factors and their severity combined with careful clinical observation, judicious use of laboratory evaluations, and empiric antibiotic treatment only in selected cases seem to be appropriate.

Keywords

newborns - early-onset neonatal sepsis - evaluation - laboratory - antibiotics

Note

There are no prior publications or submissions with any overlapping information, including studies and patients. The article has not been and will not be submitted to any other journal while it is under consideration by the American Journal of Perinatology. Dr. Riskin wrote the first draft of the article. No honorarium, grant, or other form of payment was given to anyone to produce the article. All authors have seen and approved the submission of this version of the article and take full responsibility for the article. All the authors hereby declare that they do not have any potential conflict of interests, real, or perceived.

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