Stratified Management for Bacterial Infections in Late Preterm and Term Neonates: Current Strategies and Future Opportunities Toward Precision Medicine

Abstract

Bacterial infections remain a major cause of morbidity and mortality in the neonatal period. Therefore, many neonates, including late preterm and term neonates, are exposed to antibiotics in the first weeks of life. Data on the importance of inter-individual differences and disease signatures are accumulating. Differences that may potentially influence treatment requirement and success rate. However, currently, many neonates are treated following a “one size fits all” approach, based on general protocols and standard antibiotic treatment regimens. Precision medicine has emerged in the last years and is perceived as a new, holistic, way of stratifying patients based on large-scale data including patient characteristics and disease specific features. Specific to sepsis, differences in disease susceptibility, disease severity, immune response and pharmacokinetics and -dynamics can be used for the development of treatment algorithms helping clinicians decide when and how to treat a specific patient or a specific subpopulation. In this review, we highlight the current and future developments that could allow transition to a more precise manner of antibiotic treatment in late preterm and term neonates, and propose a research agenda toward precision medicine for neonatal bacterial infections.

Use of the “Sepsis Risk Calculator” in Belgian Newborns: A Retrospective Cohort Study

“…C-reactive protein levels are, however, insufficiently specific for predicting EONS. 22,28 Increasing inconsistencies in chorioamnionitis diagnosis have recently been reported and the broadening of its definition has led studies to reevaluate whether chorioamnionitis alone should indicate empiric treatment of asymptomatic newborns. [29][30][31][32][33][34] In 2016 in California, Braun et al 32 found that in 1243 recorded chorioamnionitis, 5 (0.4%) resulted in the newborn developing EONS.…”

Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes

“…Therefore, it was reasonable that IAP reduced the occurrence of GBS EOD, which subsequently led to improved outcomes in our institute. We suspected that the occurrence of complicated GBS sepsis is associated with both host factors and factors of highly pathogenic GBS strains [ 35 , 36 ] because some healthy late preterm or term-born neonates without underlying chronic comorbidities had a very high illness severity. Therefore, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.…”

A narrative review of precision medicine in neonatal sepsis: genetic and epigenetic factors associated with disease susceptibility

“…Therefore, the identification of genetic components would potentially aid early risk stratification and individualized treatment and would provide the theoretical foundation for the clinical translation of precision medicine, which is a burgeoning paradigm intended to match the right interventions to the right population. To our knowledge, most existing papers are devoted to metabolomics, proteomics, or a subset of genomics (11)(12)(13), and no study to date has comprehensively summarized the hereditary risks of neonatal sepsis.…”