Defining neonatal sepsis

Abstract

Purpose of the review Although infection rates have modestly decreased in the neonatal intensive care unit (NICU) as a result of ongoing quality improvement measures, neonatal sepsis remains a frequent and devastating problem among hospitalized preterm neonates. Despite multiple attempts to address this unmet need, there have been minimal advances in clinical management, outcomes, and accuracy of diagnostic testing options over the last three decades. One strong contributor to a lack of medical progress is a variable case definition of disease. The inability to agree on a precise definition greatly reduces the likelihood of aligning findings from epidemiologists, clinicians, and researchers, which, in turn, severely hinders progress towards improving outcomes. Recent findings Pediatric consensus definitions for sepsis are not accurate in term infants and are not appropriate for preterm infants. In contrast to the defined multi-stage criteria for other devastating diseases encountered in the NICU (e.g., bronchopulmonary dysplasia), there is significant variability in the criteria used by investigators to substantiate the diagnosis of neonatal sepsis. Summary The lack of an accepted consensus definition for neonatal sepsis impedes our efforts towards improved diagnostic and prognostic options as well as accurate outcomes information for this vulnerable population.

Management of early‐onset neonatal sepsis differs in the north and south of Scandinavia

“…Several patients in our study were assigned a culture‐negative EONS diagnosis and received antibiotic treatment for at least three days, despite low CRP values. A review concluded that the lack of an accepted consensus definition for neonatal sepsis impeded efforts towards improved diagnostic and prognostic options for this condition . We found some marked clinical and laboratory differences between culture‐confirmed EONS and culture‐negative EONS.…”

Características clínicas y paraclínicas de recién nacidos con sepsis en un hospital nivel IV en Cali, Colombia

“…El distrés respiratorio, la bradipnea y la hipotonía (79%, 52% y 40% respectivamente), fueron los síntomas más comunes entre los pacientes del estudio, lo cual es similar a lo descrito en la literatura 10 . A pesar que en los criterios diagnósticos de infección se encuentra la distermia y la taquicardia como predictores de infección neonatal 4 , en nuestro estudio las alteraciones en la frecuencia cardiaca y en la temperatura sucedieron en menos del 40% de los pacientes.…”

“…La sepsis se define como un estado de respuesta inflamatoria sistémica que se diagnostica en los recién nacidos según factores de riesgo perinatales (fiebre materna, madre con corioamionitis, ruptura prematura de membranas de más de 18 horas, pobre control prenatal) 4 , manifestaciones clínicas (distermias, taquicardia/bradicardia, taquipnea/bradipnea, alteraciones del sistema nervioso central como letargia/irritabilidad o hipotonía, distrés respiratorio, hipoperfusión) y alteraciones paraclínicas (leucocitosis o leucopenia, bandas, PCR/procalcitonina elevada, trombocitopenia) incluyendo cultivos 5 .…”

Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand

“…Neonatal sepsis is a global challenge causing high morbidity and mortality among newborns [1][2][3][4]. The global infant mortality rate in 2014 was 29 per 1000 live births-the common cause being infection [5].…”