What’s new in the management of neonatal early-onset sepsis?

Fleiss, Noa; Schwabenbauer, Kathleen; Randis, Tara M.; Polin, Richard A.

doi:10.1136/archdischild-2021-323532

Cited by 27 publications

(21 citation statements)

References 47 publications

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“…The diagnosis of both EOS and LOS involves difficulty as sepsis in neonates usually manifests atypically [ 46 , 47 , 48 ]. Multiple common, non-infectious conditions have a similar clinical presentation to that of neonatal infection, while laboratory tests are of limited value due to their low sensitivity and the variability of normal limits in the neonatal period [ 49 ].…”

Section: Neonatal Sepsismentioning

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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Section: Neonatal Sepsismentioning

confidence: 99%

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

et al. 2023

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“…Empirical antibiotics recommended for the management of NS by different guidelines include benzylpenicillin, ampicillin or amoxicillin, and aminoglycosides (mainly gentamicin) [ 15 , 16 , 17 ]. Pediatric survey data from 56 countries support that gentamicin and ampicillin are the most prescribed antibiotics in hospitalized neonates in Africa, the Americas, the Eastern Mediterranean, Europe, and South-East Asia, while in the Western Pacific region most common are amoxicillin in combination with β-lactamase inhibitor, ceftizoxime, and meropenem [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants

et al. 2023

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Neonatal Infections are among the most common reasons for admission to the intensive care unit. Neonatal sepsis (NS) significantly contributes to mortality rates. Empiric antibiotic therapy of NS recommended by current international guidelines includes benzylpenicillin, ampicillin/amoxicillin, and aminoglycosides (gentamicin). The rise of antibacterial resistance precipitates the growth of the use of antibiotics of the Watch (second, third, and fourth generations of cephalosporines, carbapenems, macrolides, glycopeptides, rifamycins, fluoroquinolones) and Reserve groups (fifth generation of cephalosporines, oxazolidinones, lipoglycopeptides, fosfomycin), which are associated with a less clinical experience and higher risks of toxic reactions. A proper dosing regimen is essential for effective and safe antibiotic therapy, but its choice in neonates is complicated with high variability in the maturation of organ systems affecting drug absorption, distribution, metabolism, and excretion. Changes in antibiotic pharmacokinetic parameters result in altered efficacy and safety. Population pharmacokinetics can help to prognosis outcomes of antibiotic therapy, but it should be considered that the neonatal population is heterogeneous, and this heterogeneity is mainly determined by gestational and postnatal age. Preterm neonates are common in clinical practice, and due to the different physiology compared to the full terms, constitute a specific neonatal subpopulation. The objective of this review is to summarize the evidence about the developmental changes (specific for preterm and full-term infants, separately) of pharmacokinetic parameters of antibiotics used in neonatal intensive care units.

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“…The current guidelines contain three general approaches to identify newborns with an increased risk of EONS: a categorical risk factor assessment, a multivariate risk assessment (early-onset sepsis calculator) and a risk assessment primarily based on newborn clinical conditions [ 16 ]. A meta-analysis showed that the implementation of the neonatal sepsis calculator reduced the use of empirical antibiotic treatment, with a relative risk of 56% when compared to categorical approaches [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Group B Streptococcus Early-Onset Disease: New Preventive and Diagnostic Tools to Decrease the Burden of Antibiotic Use

et al. 2023

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The difficulty in recognizing early-onset neonatal sepsis (EONS) in a timely manner due to non-specific symptoms and the limitations of diagnostic tests, combined with the risk of serious consequences if EONS is not treated in a timely manner, has resulted in a low threshold for starting empirical antibiotic treatment. New guideline strategies, such as the neonatal sepsis calculator, have been proven to reduce the antibiotic burden related to EONS, but lack sensitivity for detecting EONS. In this review, the potential of novel, targeted preventive and diagnostic methods for EONS is discussed from three different perspectives: maternal, umbilical cord and newborn perspectives. Promising strategies from the maternal perspective include Group B Streptococcus (GBS) prevention, exploring the virulence factors of GBS, maternal immunization and antepartum biomarkers. The diagnostic methods obtained from the umbilical cord are preliminary but promising. Finally, promising fields from the newborn perspective include biomarkers, new microbiological techniques and clinical prediction and monitoring strategies. Consensus on the definition of EONS and the standardization of research on novel diagnostic biomarkers are crucial for future implementation and to reduce current antibiotic overexposure in newborns.

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What’s new in the management of neonatal early-onset sepsis?

Cited by 27 publications

References 47 publications

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

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

Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants

Group B Streptococcus Early-Onset Disease: New Preventive and Diagnostic Tools to Decrease the Burden of Antibiotic Use

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