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

Puopolo, Karen M.; Benitz, William Ε.; Zaoutis, Theoklis E.; Newborn,

doi:10.1542/peds.2018-2894

Cited by 279 publications

(272 citation statements)

References 77 publications

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“…Antibiotic therapy should include intravenous ampicillin for GBS, and coverage for Escherichia coli and other gramnegative bacteria implicated in neonatal sepsis, such as gentamicin, with local antibiotic resistance patterns considered [49,50]. The routine empirical use of broad-spectrum antibiotic agents should only be considered among term newborn infants who are critically ill until culture results are available.…”

Section: Eons Empiric Antibiotic Therapymentioning

confidence: 99%

“…Hence, antibiotics should be continued for symptomatic infants and those with positive blood culture [56]. Continuing empirical antibiotic therapy in response to laboratory test abnormalities alone is rarely justified, particularly among well-appearing term infants [50]. Prolonged duration of initial empirical antibiotic treatment has been associated with death and necrotizing enterocolitis among premature infants [58].…”

Section: Proven Bacterial Sepsis Without Meningitismentioning

confidence: 99%

“…In resource-poor countries, empiric antibiotic therapy should be individualized for each hospital or region [56]. Consultation with a pediatric infectious disease specialist is warranted for failure of sterilization of the bloodstream (i.e., resistant or atypical organisms) and site-specific infections [50]. The use of pentoxifylline in neonatal sepsis was demonstrated to significantly decrease all-cause mortality during hospital stays in underdeveloped or developing countries, which warrants further investigation in large randomized clinical trials in capable countries [53].…”

Section: Proven Bacterial Sepsis Without Meningitismentioning

confidence: 99%

“…The only proven preventive strategy for EONS is the appropriate administration of maternal IAP [50]. Measures that have been postulated to decrease neonatal infection in intensive care units include the consumption of 50 mL/kg/day of fresh (non-donor) human milk, and probiotics, as well as the restriction of H2-blockers, fluconazole, and lactoferrin [61].…”

Section: Prevention Strategiesmentioning

confidence: 99%

“…Measures that have been postulated to decrease neonatal infection in intensive care units include the consumption of 50 mL/kg/day of fresh (non-donor) human milk, and probiotics, as well as the restriction of H2-blockers, fluconazole, and lactoferrin [61]. Neither GBS IAP nor the aforementioned preventive measures will prevent bacterial LONS [50]. Guidelines for prevention of perinatal transmission of HSV recommend cesarean delivery for women with active genital lesions or prodromal symptoms.…”

Section: Prevention Strategiesmentioning

confidence: 99%

See 4 more Smart Citations

Neonatal Sepsis

Ershad

Mostafa

Cruz

et al. 2019

Curr Emerg Hosp Med Rep

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Section: Eons Empiric Antibiotic Therapymentioning

confidence: 99%

Section: Proven Bacterial Sepsis Without Meningitismentioning

confidence: 99%

Section: Proven Bacterial Sepsis Without Meningitismentioning

confidence: 99%

Section: Prevention Strategiesmentioning

confidence: 99%

Section: Prevention Strategiesmentioning

confidence: 99%

See 3 more Smart Citations

Neonatal Sepsis

Ershad

Mostafa

Cruz

et al. 2019

Curr Emerg Hosp Med Rep

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Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

Liang,

Wang,

Dahlen

et al. 2024

JAMA Netw Open

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IMPORTANCEUrinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes.OBJECTIVESTo examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity.DESIGN, SETTING, AND PARTICIPANTSThis retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021.EXPOSURETime periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021).MAIN OUTCOMES AND MEASURESThe primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis.RESULTSThe cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: −33.1% (95% CI, −39.4% to −26.1%) for all children and −52.1% (95% CI, −62.1% to −39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (−4.3%; 95% CI, −32.0% to 34.6% for all children) after the first 3 months of the pandemic.CONCLUSIONS AND RELEVANCEIn this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.

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Antibiotic Use in Late Preterm and Full-Term Newborns

Gyllensvärd,

Studahl,

Gustavsson

et al. 2024

JAMA Netw Open

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ImportanceAntibiotic treatment saves lives in newborns with early-onset sepsis (EOS), but unwarranted antibiotic use is associated with resistant bacteria and adverse outcomes later in life. Surveillance is needed to optimize treatment strategies.ObjectiveTo describe antibiotic use in association with the incidence and mortality from EOS among late-preterm and full-term newborns.Design, Setting, and ParticipantsThe Sweden Neonatal Antibiotic Use study was a nationwide observational study that included all late-preterm and full-term neonates born from January 1, 2012, to December 31, 2020, in neonatal units of all levels. All hospital live births from 34 weeks’ gestation during the study period were included in the study. Data were collected from the Swedish Neonatal Quality Register and the Swedish Medical Birth Register. Data were analyzed from August 2022 to May 2023.ExposureAdmission for neonatal intensive care during the first week of life.Main Outcomes and MeasuresThe main outcomes were the usage of intravenous antibiotics during the first week of life, the duration of antibiotic therapy, the rate of culture-proven EOS, and mortality associated with EOS.ResultsA total of 1 025 515 newborns were included in the study; 19 286 neonates (1.88%; 7686 girls [39.9%]; median [IQR] gestational age, 40 [38-41] weeks; median [IQR] birth weight, 3610 [3140-4030] g) received antibiotics during the first week of life, of whom 647 (3.4%) had EOS. The median (IQR) duration of antibiotic treatment in newborns without EOS was 5 (3-7) days, and there were 113 antibiotic-days per 1000 live births. During the study period there was no significant change in the exposure to neonatal antibiotics or antibiotic-days per 1000 live births. The incidence of EOS was 0.63 per 1000 live births, with a significant decrease from 0.74 in 2012 to 0.34 in 2020. Mortality associated with EOS was 1.39% (9 of 647 newborns) and did not change significantly over time. For each newborn with EOS, antibiotic treatment was initiated in 29 newborns and 173 antibiotic-days were dispensed.Conclusions and RelevanceThis large nationwide study found that a relatively low exposure to antibiotics is not associated with an increased risk of EOS or associated mortality. Still, future efforts to reduce unwarranted neonatal antibiotic use are needed.

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

Abstract: The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

Cited by 279 publications

References 77 publications

Neonatal Sepsis

Neonatal Sepsis

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

Antibiotic Use in Late Preterm and Full-Term Newborns

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