A Practical Guide to the Diagnosis, Treatment, and Prevention of Neonatal Infections

Abstract

Neonatal infections continue to cause morbidity and mortality in infants. Among approximately 400,000 infants followed nationally, the incidence rates of early-onset sepsis infection within 3 days of life are 0.98 cases per 1000 live births. Newborn infants are at increased risk for infections because they have relative immunodeficiency. This article provides evidence-based practical approaches to the diagnosis, management, and prevention of neonatal infections.

Respiratory Rate During the First 24 Hours of Life in Healthy Term Infants

“…1,2 However, unexpected diseases in the term neonate are common and may rapidly become life-threatening shortly after birth 3 ; for example, >70% of early group B streptococcal infections in the United States occur in newborns born at term. 4 Even severe diseases tend to evolve insidiously, and early detection depends on a systematic approach to identify risk factors and clinical signs of possible illness.…”

Incidence of respiratory viral infection in infants with respiratory symptoms evaluated for late-onset sepsis

“…Several respiratory viral pathogens, including coronaviruses, enterovirus, human metapneumovirus, influenza, parainfluenza, respiratory syncytial virus (RSV) and rhinovirus have been reported as possible causes of late-onset sepsis (LOS). [3][4][5] These viruses are associated with increased length of hospital stay, severe disease, unnecessary antimicrobial exposure and nosocomial outbreaks in the neonatal intensive care unit (NICU). [5][6][7] RVI is often underdiagnosed, unrecognized or infrequently examined as a cause of sepsis in infants because of several challenges: the wide range of clinical presentations and their similarity to bacterial infections 8 and the unreliable methodology previously used for RVI detection which lacked sensitivity and specificity.…”

“…[5][6][7] RVI is often underdiagnosed, unrecognized or infrequently examined as a cause of sepsis in infants because of several challenges: the wide range of clinical presentations and their similarity to bacterial infections 8 and the unreliable methodology previously used for RVI detection which lacked sensitivity and specificity. 3 The introduction of new molecular-based assays has paved the way for accurate detection of viral pathogens as a cause of sepsis in infants. The use of multiplex polymerase chain reaction (PCR) technology allows for prompt and more reliable detection of viral infection.…”

“…The use of multiplex polymerase chain reaction (PCR) technology allows for prompt and more reliable detection of viral infection. [3][4][5]9,10 Clinical suspicion for RVI promotes the detection of viral pathogens 4 using PCR technology, enhancing early recognition and facilitating the initiation of appropriate antiviral treatment 11 or prophylactic regimens. 3 Furthermore, it facilitates the withholding or discontinuation of unnecessary antimicrobial therapy, contributing to NICU-specific stewardship initiatives 12 as well as outbreak prevention.…”

“…[3][4][5]9,10 Clinical suspicion for RVI promotes the detection of viral pathogens 4 using PCR technology, enhancing early recognition and facilitating the initiation of appropriate antiviral treatment 11 or prophylactic regimens. 3 Furthermore, it facilitates the withholding or discontinuation of unnecessary antimicrobial therapy, contributing to NICU-specific stewardship initiatives 12 as well as outbreak prevention. 5 The objective of this study was to determine the frequency, etiology and impact of RVI on term and preterm infants evaluated for LOS in the NICU with clinical suspicion for viral infection.…”