Delivery Characteristics and the Risk of Early-Onset Neonatal Sepsis

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Dustin D. Flannery ◽  
Sagori Mukhopadhyay ◽  
Knashawn H. Morales ◽  
Miren B. Dhudasia ◽  
Molly Passarella ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Early Onset ◽  
Newborn Infants ◽  
Antibiotic Use ◽  
Low Risk ◽  
Membrane Rupture ◽  
Risk Characteristics ◽  
Early Onset Sepsis ◽  
Antibiotic Duration ◽  
Empirical Antibiotics

BACKGROUND AND OBJECTIVES: Multiple strategies are used to identify newborn infants at high risk of culture-confirmed early-onset sepsis (EOS). Delivery characteristics have been used to identify preterm infants at lowest risk of infection to guide initiation of empirical antibiotics. Our objectives were to identify term and preterm infants at lowest risk of EOS using delivery characteristics and to determine antibiotic use among them. METHODS: This was a retrospective cohort study of term and preterm infants born January 1, 2009 to December 31, 2014, with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Criteria for determining low EOS risk included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. We determined the association between these characteristics, incidence of EOS, and antibiotic duration among infants without EOS. RESULTS: Among 53 575 births, 7549 infants (14.1%) were evaluated and 41 (0.5%) of those evaluated had EOS. Low-risk delivery characteristics were present for 1121 (14.8%) evaluated infants, and none had EOS. Whereas antibiotics were initiated in a lower proportion of these infants (80.4% vs 91.0%, P < .001), duration of antibiotics administered to infants born with and without low-risk characteristics was not different (adjusted difference 0.6 hours, 95% CI [−3.8, 5.1]). CONCLUSIONS: Risk of EOS among infants with low-risk delivery characteristics is extremely low. Despite this, a substantial proportion of these infants are administered antibiotics. Delivery characteristics should inform empirical antibiotic management decisions among infants born at all gestational ages.

scholarly journals Evaluation of Early Onset Sepsis, Complete Blood Count, and Antibiotic Use in Gastroschisis

2017 ◽  
Vol 35 (04) ◽  
pp. 385-389
Author(s):  
Sadie Williams ◽  
Matthew Leonard ◽  
Eric Hall ◽  
Jose Perez ◽  
Jacqueline Wessel ◽  
...  
Keyword(s):  
Early Onset ◽  
Complete Blood Count ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Control Group ◽  
Typically Develop ◽  
Early Onset Sepsis ◽  
Mature Neutrophil ◽  
Reliable Marker ◽  
Culture Positive

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.

Expression of naive and memory T-cells in newborn infants with early-onset sepsis

2015 ◽  
Vol 04 (03) ◽  
pp. 233-239
Author(s):  
Diane Wooliever ◽  
Carolyn Herrington ◽  
John Lorenz ◽  
Fisal Rawas ◽  
Thomas Huard ◽  
...  
Keyword(s):  
T Cells ◽  
Early Onset ◽  
Memory T Cells ◽  
Newborn Infants ◽  
Early Onset Sepsis

Implementation and Evaluation of the Early-Onset Sepsis Risk Calculator in a High-Risk University Nursery

2017 ◽  
Vol 57 (9) ◽  
pp. 1080-1085 ◽  
Author(s):  
Jessica B. Beavers ◽  
Shasha Bai ◽  
Jennifer Perry ◽  
Jordan Simpson ◽  
Sara Peeples
Keyword(s):  
Early Onset ◽  
Neonatal Intensive Care ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Risk Calculator ◽  
Admission Rates ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Control And Prevention ◽  
Nicu Admission

There is growing interest in the Kaiser early-onset sepsis (EOS) risk calculator though institutions are hesitant to deviate from the Centers for Disease Control and Prevention guidelines and implement this in their hospitals. We describe the process of implementing routine use of the risk calculator in term and late preterm newborns delivered to mothers with chorioamnionitis in a level III neonatal intensive care unit (NICU). A retrospective chart review of infants delivered to mothers with chorioamnionitis from 2011 to 2014 was performed. Implementation of routine use of the calculator began in January 2015; preintervention and postintervention data were analyzed after a 9-month period of routine use. Following implementation, NICU admission rates, number of blood cultures drawn, and rates of antibiotic use dropped by 54%, 42%, and 59%, respectively ( P < .001). No negative outcomes were reported. In this article, we describe how the calculator was safely implemented in our NICU while decreasing the number of interventions.

scholarly journals Early-Onset Sepsis Risk Calculator: A Review Of Its Effectiveness And Comparative Study With Our Evidence-Based Local Guidelines

2021 ◽  
Author(s):  
Gianluigi Laccetta ◽  
Massimiliano Ciantelli ◽  
Cristina Tuoni ◽  
Emilio Sigali ◽  
Mario Miccoli ◽  
...  
Keyword(s):  
Gestational Age ◽  
Early Onset ◽  
Clinical Signs ◽  
Risk Calculator ◽  
Live Births ◽  
Early Onset Sepsis ◽  
Number Of Patients ◽  
Sepsis Risk ◽  
Empirical Antibiotics ◽  
Sepsis Calculator

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.

scholarly journals STUDI PENGGUNAAN ANTIBIOTIK PASIEN PNEUMONIA ANAK DENGAN METODE DDD DAN DU 90%

2021 ◽  
Vol 6 (1) ◽  
pp. 108-115
Author(s):  
Farah Bidara ◽  
◽  
Mumfasiroh Saputri ◽  
Dyah Aryani Perwitasari ◽  
Intan Fatah Kumara ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Respiratory Infections ◽  
Demographic Data ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Inpatient Ward ◽  
Daily Dose ◽  
Patient Demographic Data ◽  
Antibiotic Duration ◽  
Empirical Antibiotics

Pneumonia is one of the most common respiratory infections. The treatment of pneumonia mostly uses broad-spectrum empirical antibiotics that are susceptible to resistance. One of the efforts to reduce antibiotic resistance is to use antibiotics wisely which can be done by regularly evaluating the quantitative and qualitative use of antibiotics. The purpose of this study was to determine the quantity of consumption and the type of antibiotic used in patients pneumonia child inpatient ward at Hospital Mitra Paramedika Yogyakarta (MPY) and Yadika Pondok Bambu Jakarta (YPBJ) by DDD (Defined Daily Dose) and DU (Drug utility) 90%. This is a descriptive study period June 2017 - April 2020 in pediatric patients aged 1 - 18 years with a diagnosis of pneumonia. Sampling was performed at the Medical Record Installation. The Data taken were antibiotic type, dosage regimen, medication route, antibiotic duration (day), and hospital stay (day) as well as patient demographic data (age, type sex) .There are differences in the pattern of antibiotic use between YPBJ and MPY. Comparison of DDD and DU 90% may be due to differences in standard of therapy used by physicians, antibiotic resistance, differences in germ maps and hospital formularies.

Optimizing antibiotic use for early onset sepsis: A tertiary NICU experience

2019 ◽  
Vol 12 (3) ◽  
pp. 301-312 ◽  
Author(s):  
V. Arora ◽  
D. Strunk ◽  
S.H. Furqan ◽  
L. Schweig ◽  
C. Lefaiver ◽  
...  
Keyword(s):  
Early Onset ◽  
Antibiotic Use ◽  
Early Onset Sepsis

scholarly journals Hematologic Profiles of Ethiopian Preterm Infants With Clinical Diagnoses of Early-Onset Sepsis, Perinatal Asphyxia, and Respiratory Distress Syndrome

2020 ◽  
Vol 7 ◽  
pp. 2333794X2096026
Author(s):  
Zemene Tigabu Kebede ◽  
Yohannes Hailu Matebe ◽  
Abayneh Girma Demisse ◽  
Mulugeta Ayalew Yimer ◽  
Amha Mekasha ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Early Onset ◽  
Distress Syndrome ◽  
Perinatal Asphyxia ◽  
Platelet Counts ◽  
Early Onset Sepsis ◽  
Preterm Babies ◽  
Hematologic Profile

Objective. To determine the hematologic profile of preterm infants with regard to different diseases. Methods. A prospective, cross-sectional, observational study, conducted in 5 hospitals in Ethiopia from July 2016 to May 2018. Preterm babies <7 days of age were included and investigated with complete blood counts (CBC) and other investigations, accordingly. Results. Out of 4919 preterms, 3852 (78.3%) were admitted to a newborn intensive care unit, and of these, 68.3% had a CBC performed. The mean values of hemoglobin, white blood cell (WBC) and platelet counts were 17.9 mg/dL; 12 685 cells/mm3, and 159 340 cells/mm3, respectively. Early onset neonatal sepsis (EONS) 1433 (37%), asphyxia 266 (6.9%), and respiratory distress syndrome (RDS) 1738 (45.3%) were common reasons for admission. The WBC count was <5000 cells/mm3 for 8.8%, 9.0%, and 11.1% of neonates with EONS, asphyxia and RDS, respectively. The hemoglobin value was <7 mg/dL for 0.6%, 1.7%, and 0.4% of preterm infants with EONS, asphyxia, and RDS, respectively. The platelet count was <50 000 cells/mm3 for 16.8%, 17.7%, and 19.8% of preterms admitted with a diagnosis of EONS, asphyxia, and RDS, respectively. Conclusion. WBC and platelet counts were the most common to be associated with EONS, asphyxia, and RDS. Further study is recommended to determine the effect of abnormal hematologic profile on the outcome of preterm babies.

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