Effect of Early-Onset Sepsis Evaluations on In-Hospital Breastfeeding Practices Among Asymptomatic Term Neonates

Abstract

Early separation of asymptomatic infants from their mothers for EOS evaluation was significantly associated with delayed initiation of breastfeeding, which in turn was associated with increased formula supplementation in the first day of life. This unintended consequence of EOS evaluations among asymptomatic infants may be minimized by delaying early separation for performance of the evaluation, attempting breastfeeding initiation before separation, and/or applying more efficient criteria for identifying infants requiring evaluation.

Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

“…34,35 The impact of breastfeeding on gut dysbiosis may be important given that mother-infant separation for EOS evaluation can delay the initiation of breastfeeding and increase formula supplementation. 36 Although the relationship between early neonatal antibiotic exposure and subsequent childhood health remains to be defined, current evidence reveals that such exposures do affect newborn infants in the short-term; therefore, physicians should consider the risk/ benefit balance of initiating antibiotic therapy for the risk of EOS as well as for continuing empirical antibiotic therapy in the absence of a cultureconfirmed infection.…”

Implementation of the Sepsis Risk Calculator at an Academic Birth Hospital

“…8 Although these are undertaken to protect the newborns, such processes expose ∼5% to 10% of newborns to broad-spectrum antibiotics, separate mothers and newborns, negatively impact breastfeeding initiation, and incur an estimated $400 million to $500 million in associated costs to newborn care. [8][9][10][11][12] Multivariate models have been developed that provide an estimate of sepsis risk for the individual newborn. 6,13 These models are based on risk factors present at birth and the evolving newborn clinical condition and are available in the format of a Web-based sepsis risk calculator (SRC).…”

Phototherapy for Neonatal Unconjugated Hyperbilirubinemia: Examining Outcomes by Level of Care

“…[12][13][14][15][16][17] Additionally, although we cannot comment on the degree of mother-newborn separation that occurs in a non-ICU versus an ICU setting, it is not unreasonable to surmise that separation is more likely to occur for more hours of the day in ICU levels of care. Broadly speaking, safely minimizing mother-newborn separation is the crux of many current quality of newborn care efforts (from neonatal abstinence syndrome 18 to neonatal sepsis evaluation and management 19 ), and prescriptive IP AAP guidelines with respect to level of care would help keep more mothers and newborns together when appropriate.…”