Neonatal early-onset infections: Comparing the sensitivity of the neonatal early-onset sepsis calculator to the Dutch and the updated NICE guidelines in an observational cohort of culture-positive cases

Objective Gastroschisis is a congenital defect in which the abdominal viscera herniate through the abdominal wall. In this population, antibiotics are often initiated immediately following delivery; however, this may be unnecessary as infections typically develop as a consequence of chronic issues in gastroschisis. The objective of this study was to evaluate the incidence of culture positive early onset sepsis, the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker, and antibiotic use in infants with gastroschisis. Study Design This retrospective chart review analyzed clinical data from 103 infants with gastroschisis and 103 weight-matched controls that were evaluated for early onset infection. Results Compared with the control group, there was a significantly increased percentage of infants with an I:T ratio > 0.2 in the gastroschisis group (43% vs. 12%, p < 0.001) and an increased percentage of infants exposed to greater than 5 days of antibiotics regardless of their I:T ratio (75% vs. 6%, p < 0.001). There were no episodes of culture positive early onset sepsis in either group. Conclusion Our results indicate that I:T ratio is not a reliable marker of infection in gastroschisis, and suggest that empiric septic evaluation and antibiotic use, immediately following delivery in gastroschisis infants, may be unnecessary.

Download Full-text

Clinical profile and outcome of early onset sepsis in high risk very low birth weight neonates

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180480 ◽

2018 ◽

Vol 5 (2) ◽

pp. 389 ◽

Cited By ~ 1

Author(s):

Omprakash S. Shukla ◽

Aditi Rawat

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Blood Culture ◽

Low Birth Weight ◽

Neonatal Sepsis ◽

Early Onset ◽

Very Low Birth Weight ◽

Gram Negative ◽

Early Onset Sepsis ◽

Culture Positive

Background: Neonatal sepsis is one of the main causes of mortality and morbidity, especially in very low birth weight neonates (birth weight <1499 grams) despite the progress in hygiene, introduction of new and potent antimicrobial agents for treatment and advanced measures for diagnosis. The aim of the study was to find correlation of clinical features and risk factors of neonatal sepsis in culture positive cases.Methods: A cross- sectional study was carried out in one hundred neonates with risk factors of septicemia after obtaining informed consent. Blood culture was done using Bactec Peds Plus/F Culture as a gold standard to diagnose septicaemia. Correlation of risk factors, clinical features with laboratory findings was obtained by using chi-square test. p-value of less than 0.05 was considered as significant.Results: Out of 100 neonates with suspected sepsis, BACTEC culture proven sepsis was seen in 40% cases. Gram negative sepsis was seen in 62.5% cases. The most common bacteria for early onset sepsis were Klebsiella, Pseudomonas and MRSA contributing 17% each to the bacteriological profile. The most common predisposing factor and clinical feature in culture positive cases were Premature rupture of membrane >24 hours (67%) and bleeding/petechia/pupura (72%) respectively. The major cause of mortality was pulmonary hemorrhage.Conclusions: Gram negative organism were more common and associated with higher mortality. Blood culture positivity increases with increase in number of risk factors in neonatal septicemia. A detailed history and thorough clinical examination is vital for early recognition of sepsis.

Download Full-text

Potential benefit from the implementation of the Kaiser Permanente neonatal early-onset sepsis calculator on clinical management of neonates with presumed sepsis

European Journal of Pediatrics ◽

10.1007/s00431-021-04282-x ◽

2021 ◽

Author(s):

Ioannis Kopsidas ◽

Nafsika-Maria Molocha ◽

Eleni Kourkouni ◽

Susan Coffin ◽

Despoina Gkentzi ◽

...

Keyword(s):

Clinical Management ◽

Early Onset ◽

Potential Benefit ◽

Kaiser Permanente ◽

Early Onset Sepsis ◽

Sepsis Calculator

Download Full-text

Association between sepsis calculator and infection parameters for newborns with suspected early onset sepsis

Journal of Clinical Neonatology ◽

10.4103/jcn.jcn_110_16 ◽

2017 ◽

Vol 6 (3) ◽

pp. 159

Author(s):

NiekB Achten ◽

Rens Zonneveld ◽

Ellen Tromp ◽

FransB Plötz

Keyword(s):

Early Onset ◽

Early Onset Sepsis ◽

Infection Parameters ◽

Sepsis Calculator

Download Full-text

Evaluation of compliance with the 2017 Canadian Paediatric Society Position Statement for the management of newborns at risk for early-onset sepsis: A retrospective cohort study

Paediatrics & Child Health ◽

10.1093/pch/pxaa042 ◽

2020 ◽

Author(s):

Marina Simeonova ◽

Jolanta Piszczek ◽

Sannifer Hoi ◽

Curtis Harder ◽

Gustavo Pelligra

Keyword(s):

Risk Factors ◽

At Risk ◽

Early Onset ◽

Management Strategies ◽

Retrospective Chart Review ◽

Position Statement ◽

Paediatric Society ◽

Early Onset Sepsis ◽

Inappropriate Antibiotics ◽

Culture Positive

Abstract Introduction Due to the nonspecific clinical presentation, clinicians often empirically treat newborns at risk of early-onset sepsis (EOS). Recently, the Canadian Paediatric Society (CPS) published updated recommendations that promote a more judicious approach to EOS management. Objective To examine the compliance with the CPS statement at a tertiary perinatal site and characterize the types of deviations. Methods A retrospective chart review was conducted for all term and late pre-term newborns at risk for sepsis, between January 1 and June 30, 2018. The prevalence of newborns with EOS risk factors was measured during the first month. Management strategies for eligible newborns during the 6-month period were compared to the CPS recommendations to establish the rate of noncompliance. The type of noncompliance, readmission rate, and rate of culture-positive EOS were examined. Results In the first month, 29% (66 of 228) of newborns had EOS risk factors. Among the 100 newborns born in the 6-month period for whom the CPS recommendations apply, 47 (47%) received noncompliant management. Of those, 51% (N=24) had inappropriately initiated investigations, 17% (N=8) had inappropriate antibiotics, and 32% (N=15) had both. The rate of readmission for a septic workup was 1.6% (N= 2). None had culture-positive sepsis while admitted. Conclusion A large proportion of term and late preterm newborns (29%) had EOS risk factors, but none had culture-confirmed EOS. The rate of noncompliance with the CPS recommendations was high (47%), mainly due to overzealous management. Future initiatives should aim at increasing compliance, particularly in newborns at lower EOS risk.

Download Full-text