Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis
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Open Access
- 1 May 2012
- journal article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 129 (5), 1006-1015
- https://doi.org/10.1542/peds.2012-0541
Abstract
With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. 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.Keywords
This publication has 82 references indexed in Scilit:
- Prolonged Initial Empirical Antibiotic Treatment is Associated with Adverse Outcomes in Premature InfantsThe Journal of Pediatrics, 2011
- Antibiotic Exposure in the Newborn Intensive Care Unit and the Risk of Necrotizing EnterocolitisThe Journal of Pediatrics, 2011
- Age‐specific reference values for cerebrospinal fluid protein concentration in neonates and young infantsJournal of Hospital Medicine, 2011
- Normative Cerebrospinal Fluid Profiles in Febrile InfantsThe Journal of Pediatrics, 2010
- Role of Innate Host Defenses in Susceptibility to Early-Onset Neonatal SepsisClinics in Perinatology, 2010
- Diagnosis and Management of Clinical ChorioamnionitisClinics in Perinatology, 2010
- Ureaplasma Species: Role in Diseases of PrematurityClinics in Perinatology, 2010
- Meningitis in Preterm Neonates: Importance of Cerebrospinal Fluid ParametersAmerican Journal of Perinatology, 2008
- A comparison of neonatal Gram-negative rod and Gram-positive cocci meningitisJournal of Perinatology, 2006
- Acute-Phase Proteins and Other Systemic Responses to InflammationNew England Journal of Medicine, 1999