NICE clinical guideline: antibiotics for the prevention and treatment of early-onset neonatal infection: Table 1

High flow nasal cannula versus NCPAP, duration to full oral feeds in preterm infants: a randomised controlled trial

“…We recorded basic demographic data (including gestational age at birth, birth weight, Apgar scores, antenatal steroids, mode of delivery). We have also recorded incidence of RDS, need for endotracheal ventilation, incidence of patent ductus arteriosus (defined as presence of patent ductus arteriosus beyond the first 72 hours of life), incidence of necrotising enterocolitis (≥IIA according to modified Bell's criteria)12 and incidence of early onset sepsis (using definitions published in the National Institute for Health and Care Excellence guidelines) 13…”

Efficacy and safety of applying a neonatal early‐onset sepsis risk calculator in China

“…Different from paediatric or adult sepsis, the positive blood culture in neonatal EOS is especially low and variable in different regions of the world as indicated by a previous study (0.1–3.3%) . Current guidelines put great emphasis on the clinical signs of EOS in the diagnosis of EOS compared to their emphasis on laboratory findings . However, because of the non‐specific nature and late occurrence of EOS, diagnosis of EOS can be difficult, can be delayed and can sometimes strongly depend on the experience of clinicians.…”

“…[13][14][15] Current guidelines put great emphasis on the clinical signs of EOS in the diagnosis of EOS compared to their emphasis on laboratory findings. 16,17 However, because of the non-specific nature and late occurrence of EOS, diagnosis of EOS can be difficult, can be delayed and can sometimes strongly depend on the experience of clinicians. A survey among 81 nurseries found that substantial variation exists in EOS risk assessment, and this has an influence on final EOS diagnosis and treatment.…”

C‐reactive protein and immature‐to‐total neutrophil ratio have no utility in guiding lumbar puncture in suspected neonatal sepsis

“…The American Academy of Pediatrics guidelines recommend performing an LP in infants with a positive blood culture and/or a clinical course or laboratory data (including raised inflammatory markers, for which no threshold is given) that strongly suggest bacterial sepsis or in infants who deteriorate despite antimicrobial therapy . Similarly, the UK National Institute for Clinical Excellence guideline indicates that an LP should be considered in the context of clinical sepsis/meningitis, positive blood culture, no clinical improvement (despite treatment) and if the C‐reactive protein (CRP) is >10 mg/L . There is an increased incidence of meningitis in bacteraemic infants, but performing an LP after blood cultures are positive may result in diagnostic delay or false negative CSF culture due to empiric antibiotic therapy …”

“…7 Similarly, the UK National Institute for Clinical Excellence guideline indicates that an LP should be considered in the context of clinical sepsis/meningitis, positive blood culture, no clinical improvement (despite treatment) and if the C-reactive protein (CRP) is >10 mg/L. 8 There is an increased incidence of meningitis in bacteraemic infants, but performing an LP after blood cultures are positive may result in diagnostic delay or false negative CSF culture due to empiric antibiotic therapy. 9,10 In our unit, a large metropolitan level 3 neonatal intensive care unit (NICU), we have adopted the American Academy of Pediatrics approach, generally performing an LP if there is a positive blood culture (except for coagulase-negative staphylococci (CONS)), if there is a clinical suspicion of meningitis or if CRP is >25-30 mg/L.…”