Clinical Characteristics of Early Onset Sepsis in Micropreemie Born at 25 or Less than 25 Weeks of Gestational Age

Abstract Background According to most early-onset sepsis management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. Early-onset sepsis risk calculator has been developed with the purpose of avoiding antibiotic overtreatment among neonates ≥ 34 weeks’ gestational age: a review of literature demonstrates its effectiveness in reducing antibiotic overtreatment, laboratory testing, painful procedures and NICU admission; however, some missed cases of culture-positive early-onset sepsis have also been described. Methods All neonates with birth weight ≤ 1500 g, 34–36 weeks’ gestational age neonates with suspected intraamniotic infection and neonates with three clinical signs of early-onset sepsis or two signs and one risk factor for early-onset sepsis receive empirical antibiotics. Neonates ≥ 34 weeks’ gestational age with risk factors for early-onset sepsis or with one clinical indicator of early-onset sepsis undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 hours of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of early-onset sepsis. We therefore compared the number of patients for which antibiotics were needed, based on early-onset sepsis calculator, and the number of patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05. Results During the study period (1st January 2018-31st December 2018) 32/265 (12.1%) neonates ≥ 34 weeks’ gestational age at risk for early-onset sepsis received antibiotics within the first 12 hours of life. According to early-onset sepsis calculator: 55/265 (20.7%) patients would have received antibiotics with early-onset sepsis incidence 2/1000 live births (p < 0.0001); 44/265 (16.6%) patients would have received antibiotics with early-onset sepsis incidence 0.1/1000 live births (p < 0.025). One patient with culture-negative early-onset sepsis would not have received antibiotics with an early-onset sepsis incidence of 0.1/1000 live births. Conclusion Our evidence-based protocol for treatment decision-making of neonatal early-onset sepsis entails a further decrease of antibiotic overtreatment compared to early-onset sepsis risk calculator. No negative consequences for patients were observed.

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Managing Infants Exposed to Maternal Chorioamnionitis by the Use of Early-Onset Sepsis Calculator

Global Pediatric Health ◽

10.1177/2333794x19833711 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1983371 ◽

Cited By ~ 1

Author(s):

Vinay Sharma ◽

Constance Adkisson ◽

Kunal Gupta

Keyword(s):

Gestational Age ◽

Early Onset ◽

Neonatal Intensive Care ◽

Complete Blood Count ◽

Admission Rate ◽

Antibiotic Use ◽

Laboratory Evaluation ◽

Utilization Rate ◽

Early Onset Sepsis ◽

Sepsis Calculator

Objective. To reduce neonatal intensive care unit admission rate (NAR) and antibiotic utilization rate (AUR) in ≥36 weeks gestational age infants exposed to maternal chorioamnionitis (MC) through the application of early-onset sepsis calculator (EOSCAL). Study Design. This is a single-center cohort study. All infants born ≥36 weeks gestational age and exposed to MC were compared for NAR, AUR, and laboratory evaluation rate (LER) 2 years after and 1 year before the implementation of EOSCAL. Results. There is a significant decrease in NAR ( P < .001), AUR ( P < .04), and LER for blood culture, complete blood count, and C-reactive protein ( P < .001) after implementation of EOSCAL. If infants received antibiotics, it was for significantly less number of doses ( P < .01). There was no increase in the readmission rate. Conclusion. Use of EOSCAL significantly decreases the rate of NAR, AUR, and LER in infants exposed to MC, without affecting readmission rates and late antibiotic use.

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Reduction of Duration of Antibiotic Therapy for Suspected Early-Onset Sepsis in Late-Preterm and Term Newborns After Implementation of a Procalcitonin-Guided Algorithm: A Population-Based Study in Central Switzerland

Frontiers in Pediatrics ◽

10.3389/fped.2021.702133 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jennifer Zihlmann-Ji ◽

Christian Braun ◽

Michael Buettcher ◽

Markus Hodel ◽

Dirk Lehnick ◽

...

Keyword(s):

Antibiotic Therapy ◽

Gestational Age ◽

Early Onset ◽

Population Based ◽

Unintended Consequences ◽

Late Preterm ◽

Population Based Study ◽

Early Onset Sepsis ◽

Central Switzerland ◽

Guided Therapy

Background: Suspected early-onset sepsis (EOS) is the main reason for antibiotic therapy at the start of life. Prolonged antibiotic therapy for culture-negative sepsis is often reported. Antibiotic stewardship is mandatory due to the potential negative effects of unnecessary antibiotics. Procalcitonin (PCT)-guided therapy is one possible strategy with published evidence to shorten antibiotic therapy. The aim of this study is to analyze the feasibility and the performance of the published PCT-algorithm in the clinical setting without study support.Methods: This is a retrospective, population-based study regarding duration of antibiotic therapy for suspected EOS in Central Switzerland between 2014 and 2018. All neonates >34 0/7 weeks of gestational age started on antibiotic therapy for suspected EOS within the first 3 calendar days of life were included. The Procalcitonin-guided algorithm according to the NeoPInS study was used as strategy to determine duration of antibiotic therapy.Results: In a population-based cohort of 35,642 life born neonates, the duration of antibiotic therapy of 879 neonates (2.5% of the cohort) treated for suspected EOS was 4 calendar days (median, IQR 2–5). We observed a statistically significant reduction from 4 (median, IQR 3–6) to 3 calendar days (median, IQR 2–4) from 2014 to 2018. Duration of antibiotic therapy was independent of gestational age (late-preterm vs. term neonates), of the presence of risk factors or clinical signs, but dependent on the presence of abnormal laboratory measurements (C-reactive protein > 10 mg/l or leukocytopenia <5 Giga/l) before start of antibiotic therapy (p < 0.01).Conclusions: PCT-guided therapy using the NeoPInS algorithm is feasible and may lead to reduced duration of antibiotic therapy for suspected EOS as reported in the original study. We observed a learning curve to the new algorithm which may be explained as change process. The use of biomarker to guide duration of antibiotic therapy for suspected EOS may have unintended consequences with prolongation of antibiotic therapy in some cases.

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Comparison of Risk for Early-onset Sepsis in Small-for-gestational-age Neonates and Appropriate-for-gestational-age Neonates Based on Lower Levels of White Blood Cell, Neutrophil, and Platelet Counts

Pediatrics & Neonatology ◽

10.1016/j.pedneo.2013.12.006 ◽

2014 ◽

Vol 55 (4) ◽

pp. 323-325 ◽

Cited By ~ 2

Author(s):

Nora Hofer ◽

Silvia Edlinger ◽

Bernhard Resch

Keyword(s):

Blood Cell ◽

White Blood Cell ◽

Gestational Age ◽

Small For Gestational Age ◽

Early Onset ◽

Platelet Counts ◽

Early Onset Sepsis ◽

Appropriate For Gestational Age

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P26 An audit of the use of amikacin for early onset sepsis in premature neonates in an inpatient neonatal unit

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314584.37 ◽

2018 ◽

Vol 103 (2) ◽

pp. e1.31-e1

Author(s):

Dalton Caroline ◽

Benzaken Tami ◽

Tyszczuk Lidia ◽

Gozar Ioana

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Early Onset ◽

Ductus Arteriosus ◽

Neonatal Infection ◽

Extremely Low Birth Weight ◽

List Type ◽

Premature Neonates ◽

Early Onset Sepsis ◽

Trough Levels

AimIn April 2017 the Trust updated the Neonatal Infection Guideline due to increasing resistance to gentamicin. Subsequently, the first line aminoglycoside to treat early onset sepsis (EOS) on neonatal units (NNU) for patients ≤32 weeks gestation changed from gentamicin to amikacin.Updated guidance recommends prescribing amikacin 15 mg/kg 24 hourly, aiming for trough levels<5 mg/L; however anecdotal reports suggest this results in frequently high trough levels at 24 hours.Adherence to current guidelines was audited, to gain insight into the most appropriate dosing interval to use, particularly in extremely low birth weight (<1 kg) and extremely premature neonates (<28 weeks gestation at birth).Audit aims100% of patients prescribed amikacin for EOS adhere to criteria in Neonatal Infection Guideline100% of patients prescribed amikacin dose of 15 mg/kg100% of patients prescribed amikacin have a blood level taken at 24 hours (prior to giving second dose)100% of patients receive further doses of amikacin only when blood levels are <5 mg/L, or under the advice of a pharmacistMethodAudit standards were derived from hospital policy. All eligible neonates receiving amikacin were included. Neonates on postnatal wards were excluded; they should receive gentamicin for treatment of EOS.Prospective data collection was completed across both NNUs at the Trust, which included all neonates that received doses of amikacin from 1st April to 1st August 2017. Data were collected from drug charts and medical records. Data were also collected to account for factors that could contribute to or highlight that the patient suffered from poor renal output; degree of prematurity (gestational age), urine output, urea and electrolytes, any inotropic support, or a significant patent ductus arteriosus. Data were entered onto an Excel spread sheet and were summarised descriptively. The audit was approved locally.ResultsA total of 50 neonates received amikacin. 100% adhered to criteria in Neonatal Infection Guideline and 100% prescribed doses of 15 mg/kg. 12 patients (24%) did not have an amikacin level taken at 24 hours, of which 5 (42%) had stopped antibiotics and 7 (58%) had levels taken between 27–36 hours. Of the remaining 38 patients, only 6 (16%) had levels<5 mg/L at 24 hours. Nine (24%) patients then stopped antibiotics at 36 hours. 23 patients had levels taken at 36 hours, of which 17 (74%) could be classed as ‘in range’ at ≤5 mg/L. Two patients received doses despite levels of >5 mg/L. Final results are yet to be fully analysed, however it appears as though there is no direct correlation between gestational age, severity of illness and amikacin level results.ConclusionFindings suggest it is difficult to pre-determine how a patient will excrete amikacin, even when taking into account gestational age and birth weight; which would support the literature.¹ However, the majority of levels were high at 24 hours and within range by 36 hours, so change in practice from 24 hourly to 36 hourly dosing is recommended. Following implementation of the recommendations, further audit is necessary in one year.ReferenceAllegaert K, Anderson BJ, Cossey V, et al. Limited predictability of amikacin clearance in extreme premature neonates at birth. British Journal of Clinical Pharmacology2005;61:39–48.

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Bax Expression of Throphoblast Cells did not Differ between Early and Late Onset Preeclampsia

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v9i3.1430 ◽

2021 ◽

pp. 126-129

Author(s):

Made Ariyana ◽

Diah R. Hadiati ◽

Irwan T. Rachman ◽

Dewajani Purnomosari

Keyword(s):

Protein Expression ◽

Gestational Age ◽

Early Onset ◽

Clinical Characteristics ◽

Late Onset ◽

Placental Tissue ◽

Cross Sectional Study ◽

Cross Sectional ◽

Bax Protein ◽

Study Population

Objective: To compare Bax protein expression in throphoblast cells of early and late onset PE. Methods: A cross sectional study involving 36 cases of early onset PE and 36 cases of late onset PE was conducted. Bax protein expression was evaluated from sample of placental tissue collected from the study population and calculated using H-Score. Data on age, number of parity, gestational age, body mass index was collected from the medical records. Expression of Bax was compared using Mann-Whitney test. Results: There was no difference in the clinical characteristics (age, number of parity, BMI, SBP, DBP, and MAP) between the two groups. There was no difference in the expression of Bax protein between the early and late onset PE (mean H-score early vs. late onset PE: 1.48 vs 1.46, p=0.814, Mann Whitney U test). Clinical characteristics of the study population also did not correlate with the Bax expression (R for number of parity: 0.052, age: 0.009, gestational age: -0.014, BMI: 0.063, all p values were >0.05, linear regresion). Conclusion: There is no difference in the expression of Bax protein of throphoblast cells between early and late onset PE. Keyword: apoptosis, BAX, early onset, late onset, preeclampsia Abstrak Tujuan: Untuk membandingkan ekspresi protein Bax dalam sel trofoblas pada preeklamsia (PE) onset dini dan lambat. Metode: Sebuah studi potong lintang yang melibatkan 36 kasus PE onset dini dan 36 kasus PE onset lambat dilakukan. Ekspresi protein Bax dievaluasi dari sampel jaringan plasenta yang dikumpulkan dari populasi studi dan dihitung menggunakan skor-H. Data usia, jumlah paritas, usia kehamilan, indeks massa tubuh dikumpulkan dari rekam medis. Ekspresi Bax dibandingkan menggunakan uji Mann-Whitney. Results: Tidak terdapat perbedaan pada karakteristik klinis (usia, jumlah paritas, IMT, TDS, TDD, dan MAP) antara kedua kelompok. Tidak terdapat perbedaan dalam ekspresi protein Bax antara PE onset dini dan lambat (rata-rata H-skor PE onset dini dan lambat: 1.48 vs 1.46, p = 0.814, uji Mann Whitney U). Karakteristik klinis populasi studi juga tidak berkorelasi dengan ekspresi Bax (R untuk jumlah paritas: 0,052, usia: 0,009, usia kehamilan: -0,014, BMI: 0,063, nilai p dari semua variable tersebut adalah sebesar >0,05, dengan menggunakan regresi linier). Kesimpulan: Tidak terdapat perbedaan dalam ekspresi protein Bax pada sel trofoblas antara PE onset dini dan lambat. Kata kunci: apoptosis, BAX, onset dini, onset lambat, preeklamsia

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