Management of Late-Preterm and Term Neonates at Risk for Early-Onset Sepsis

BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r = 0.82, p < 0.05) in the cohort (n = 350) and in population subsets (r = 0.81–0.9, p < 0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p < 0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p < 0.001], DC + status [beta (SE) =−0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p < 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

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The Centers for Disease Control and Prevention guidelines identified more neonates at risk of early onset sepsis than the Kaiser‐Permanente calculator

Acta Paediatrica ◽

10.1111/apa.16232 ◽

2021 ◽

Author(s):

Calanit Hershkovich–Shporen ◽

Alex Guri ◽

Tatiana Gluskina ◽

Orna Flidel‐Rimon

Keyword(s):

At Risk ◽

Disease Control ◽

Early Onset ◽

Kaiser Permanente ◽

Early Onset Sepsis ◽

Control And Prevention ◽

Prevention Guidelines ◽

Centers For Disease Control

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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.

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