Epidemiology and trends in neonatal early onset sepsis in California, 2010–2017

Joshi, Neha S.; Huynh, Karen; Lu, Tianyao; Lee, Henry; Frymoyer, Adam

doi:10.1038/s41372-022-01393-7

Cited by 13 publications

(12 citation statements)

References 29 publications

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“…Secondary clinically-associated outcomes: 1) blood culture-positive EOS, which did not include organisms commonly considered contaminants, including coagulase-negative staphylococcus, 23,24 2) prolonged antibiotic receipt ≥72 hours (as a proxy for culture-negative sepsis 25–28 and/or “sicker” infant), 3) hypoglycemia (at least one blood glucose measurement of <35 mg/dL if <4 hours following birth or <45 mg/dL if ≥4 hours following birth), 4a) maximum percent weight loss during the period from birth until 72 or 96 hours after birth for vaginal and cesarean deliveries, respectively, or until discharge, whichever occurred first, 4b) proportion of infants with maximum percent weight loss above the vaginal or cesarean 75 th percentile curves on the Newborn Weight Loss Tool (NEWT), 29–31 5) length of stay (days), and 6) readmission to a Stanford-affiliated hospital within 14 days of nursery discharge.…”

Section: Methodsmentioning

confidence: 99%

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery

Dang,

Patel,

Weng

et al. 2023

Preprint

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Background and ObjectivesNeonatal hypothermia has been shown to be commonly detected among late preterm and term infants. In preterm and very low birth weight infants, hypothermia is associated with increased morbidity and mortality. Little is known about the clinical interventions and outcomes in hypothermic late preterm and term infants. This study fills this gap in the evidence.MethodsSingle-center retrospective cohort study using electronic health record data on infants ≥35 weeks’ gestation admitted to a newborn nursery from 2015-2021. Hypothermia was categorized by severity: none, mild (single episode, 36.0-36.4°C), and moderate/severe (recurrent episodes and/or <36.0°C). Bivariable and multivariable logistic regression examined associations between hypothermia and interventions/outcomes. Stratified analyses by effect modifiers were conducted when appropriate.ResultsAmong 24,009 infants, 1,111 had moderate/severe hypothermia. These hypothermic infants had higher odds of NICU transfer (aOR 2.10, 95% CI 1.68-2.60), sepsis evaluation (aOR 2.23, 95% CI 1.73-2.84), and antibiotic use (aOR 1.73, 95% CI 1.15-2.50) than infants without hypothermia. No infants with hypothermia had culture-positive sepsis and receipt of antibiotics ≥72 hours (surrogate for culture-negative sepsis and/or higher severity of illness) was not more common in hypothermic infants. Hypothermic infants also had higher odds of blood glucose measurement and hypoglycemia, higher percent weight loss and longer lengths of stay.ConclusionLate preterm and term infants with hypothermia in the nursery have potentially unnecessary increased resource utilization. Evidence-based and value-driven approaches to hypothermia in this population are needed.What’s Known on This SubjectNeonatal hypothermia has been associated with morbidity and mortality in high-risk (preterm and very low birth weight) infants. The clinical implications of hypothermia in otherwise healthy late preterm and term infants admitted to the newborn nursery are poorly defined.What This Study AddsInfants with moderate/severe hypothermia have higher odds of diagnostic interventions and NICU transfers than infants without hypothermia. No infants with hypothermia had culture-positive sepsis. With the lack of a strong evidence base, hypothermia may drive unnecessary resource overutilization.

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Section: Methodsmentioning

confidence: 99%

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery

Dang,

Patel,

Weng

et al. 2023

Preprint

Self Cite

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“…The estimated incidence of EOS in Europe was 0.28 to 2.1 episodes/1000 live births [ 4 , 5 , 6 ]. In the U.S., the incidence was 7.4/1000 in preterm, 0.76/1000 in late preterm, and 0.31/1000 in term neonates [ 7 ]. Late-onset sepsis (LOS) occurs after the first 72 h of life and is mainly associated with factors in the neonatal intensive care unit (NICU), with the greatest incidence reported between the tenth and the twenty-second day of life [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Fighting Antimicrobial Resistance in Neonatal Intensive Care Units: Rational Use of Antibiotics in Neonatal Sepsis

et al. 2023

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Antibiotics are the most frequently prescribed drugs in neonatal intensive care units (NICUs) due to the severity of complications accompanying neonatal sepsis. However, antimicrobial drugs are often used inappropriately due to the difficulties in diagnosing sepsis in the neonatal population. The reckless use of antibiotics leads to the development of resistant strains, rendering multidrug-resistant pathogens a serious problem in NICUs and a global threat to public health. The aim of this narrative review is to provide a brief overview of neonatal sepsis and an update on the data regarding indications for antimicrobial therapy initiation, current guidance in the empirical antimicrobial selection and duration of therapy, and indications for early discontinuation.

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“…The Centers for Disease Control and Prevention (CDC) estimated that incidence has reduced from more than 1.5/1000 births in the early 1990s to less than 0.5/1000 births in recent years. Despite this positive trend, EOS still represents a serious problem for the neonatal population [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

et al. 2022

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Current neonatal early-onset sepsis (EOS) guidelines lack consensus. Recent studies suggest three different options for EOS risk assessment among infants born ≥35 wks gestational age (GA), leading to different behaviors in the sepsis workup and antibiotic administration. A broad disparity in clinical practice is found in Neonatal Units, with a large number of non-infected newborns evaluated and treated for EOS. Broad spectrum antibiotics in early life may induce different short- and long-term adverse effects, longer hospitalization, and early mother-child separation. In this single-center prospective study, a total of 3002 neonates born in three periods between 2016 and 2020 were studied, and three different workup algorithms were compared: the first one was based on the categorical risk assessment; the second one was based on a Serial Physical Examination (SPE) strategy for infants with EOS risk factors; the third one associated an informatic tool (Neonatal EOS calculator) with a universal extension of the SPE strategy. The main objective of this study was to reduce the number of neonatal sepsis workups and the rate of antibiotic administration and favor rooming-in and mother–infant bonding without increasing the risk of sepsis and mortality. The combined strategy of universal SPE with the EOS Calculator showed a significant reduction of laboratory tests (from 33% to 6.6%; p < 0.01) and antibiotic treatments (from 8.5% to 1.4%; p < 0.01) in term and near-term newborns. EOS and mortality did not change significantly during the study period.

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Epidemiology and trends in neonatal early onset sepsis in California, 2010–2017

Cited by 13 publications

References 29 publications

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery

Fighting Antimicrobial Resistance in Neonatal Intensive Care Units: Rational Use of Antibiotics in Neonatal Sepsis

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

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