scholarly journals Relevance of Biomarkers Currently in Use or Research for Practical Diagnosis Approach of Neonatal Early-Onset Sepsis

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 309
Author(s):  
Maura-Adelina Hincu ◽  
Gabriela-Ildiko Zonda ◽  
Gabriela Dumitrita Stanciu ◽  
Dragos Nemescu ◽  
Luminita Paduraru
Keyword(s):  
High Mortality ◽  
Early Onset ◽  
Clinical Signs ◽  
Developed Countries ◽  
Extremely Low Birth Weight ◽  
Invasive Infection ◽  
Acute Phase Reactants ◽  
Hematological Indices ◽  
Live Births ◽  
Early Onset Sepsis

Neonatal early-onset sepsis (EOS) is defined as an invasive infection that occurs in the first 72 h of life. The incidence of EOS varies from 0.5–2% live births in developed countries, up to 9.8% live births in low resource settings, generating a high mortality rate, especially in extremely low birth weight neonates. Clinical signs are nonspecific, leading to a late diagnosis and high mortality. Currently, there are several markers used for sepsis evaluation, such as hematological indices, acute phase reactants, cytokines, which by themselves do not show acceptable sensitivity and specificity for the diagnosis of EOS in neonates. Newer and more selective markers have surfaced recently, such as presepsin and endocan, but they are currently only in the experimental research stages. This comprehensive review article is based on the role of biomarkers currently in use or in the research phase from a basic, translational, and clinical viewpoint that helps us to improve the quality of neonatal early-onset sepsis diagnosis and management.

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 Incidence and factors associated with mortality of neonatal sepsis

2011 ◽  
Vol 51 (3) ◽  
pp. 144 ◽  
Author(s):  
I Made Kardana
Keyword(s):  
Birth Weight ◽  
Mortality Rate ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Mode Of Delivery ◽  
Developed Countries ◽  
Live Births ◽  
Factors Associated ◽  
Early Onset Sepsis

Background Neonatal sepsis is one of the major causes of mortality and long term morbidity in neonates, particularly in premature and low birth weight infants. The incidence of neonatal sepsis varies from 1 to 4 in 1000 live births in developed countries and 10 to 50 in 1000 live births in developing countries. The mortality rate of neonatal sepsis remains high, especially in developing countries.Objective To describe the incidence, mortality rate, and factors associated 'With mortality in neonatal sepsis in Sanglah Hospital, Denpasar.Methods A retrospective, cohort study was conducted in the Perinatology Ward, Department of Child Health, Sanglah Hospital, Denpasar, Bali from January to December 2008. One hundred thirty􀁄eight patients 'With neonatal sepsis were enrolled in this study. Patients' characteristic data were collected including sex, mode of delivery (spontaneous, non􀁄spontaneous), condition at birth (vigorous, asphyxic), gestational age (premature, full tenn), birth weight «2500 grams, > 2500 grams), and sepsis classifica􀁄tion (early onset sepsis, late onset sepsis). Outcomes were grouped into alive and dead.Results A total of 138 cases of neonatal sepsis were reviewed, 59.4% of whom were boys, 63.0% spontaneously delivered,39.1 % asphyxic, 53.6% 'With low birth weight, 50.7% premature, and84.8% with early onset sepsis. The incidence of neonatal sepsis was 5% of babies admitted, 'With a mortality rate of 28.3%. Low birth weight and prematurity were significantly associated withmortality in neonatal sepsis (RR8.4, 95% CI 2.4 to 29.0, P = 0.001 and RR3.4, 95% ClI.O to 11.0, P 􀀂 0.042, respectively). Conclusion The incidence of neonatal sepsis in Sanglah Hospital was 5% of babies admitted, with a mortality rate of 28.3%. Low birth weight and prematurity were significantly associated with mortality in neonatal sepsis. 2011;51:144-8].

Duration of Empiric Antibiotics for Suspected Early-Onset Sepsis in Extremely Low Birth Weight Infants

2003 ◽  
Vol 24 (9) ◽  
pp. 662-666 ◽  
Author(s):  
Leandro Cordero ◽  
Leona W. Ayers
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Early Onset ◽  
Clinical Signs ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Empiric Antibiotics ◽  
Academic Hospitals ◽  
Early Onset Sepsis ◽  
Long Course

AbstractObjectives:To study multicenter antibiotic practices for suspected early-onset sepsis (EOS) with negative blood cultures (NegBCs) and to identify opportunities for reduction of antimicrobial exposure.Design:Retrospective study.Setting:Thirty academic hospitals (University HealthSystem Consortium) located in 24 states.Methods:Data were from a survey of 790 extremely low birth weight (ELBW) infants. Total antibiotic exposures (antibiotic-days per patient) were calculated.Results:On admission to the NICU, 94% of 790 ELBW infants had BCs performed and empiric antibiotics initiated. When PosBC and NegBC infants were compared, 47 patients with PosBCs were similar to 695 with NegBCs in birth weight, gestational age (GA), and mortality. Patients with suspected EOS but NegBCs given ampicillin/aminoglycosides were grouped by length of administration and GA. For GA of 26 weeks or younger, 170 infants given a short (≤ 3 days) and 157 given a long (≥ 7 days) course were similar regarding birth weight, mortality, antepartum history, and CRIB scores, but were different (P < .01) in number receiving a third antimicrobial (3% and 17%) and antibiotic-days (23 and 38). For GA of 27 weeks or older, 113 infants given a short and 77 given a long course differed (P < .01) in number receiving a third antimicrobial (2% and 23%) and antibiotic-days (19 and 30).Conclusions:Most suspected EOS infants with NegBCs are given antibiotics, but no antepartum historical risk factors or neonatal clinical signs explained prolonged administration. Discontinuing empiric antibiotics when BCs are negative in asymptomatic ELBW infants can reduce antimicrobial exposure without compromising clinical outcome.

scholarly journals To screen or not to screen women for Group B Streptococcus (Streptococcus agalactiae) to prevent early onset sepsis in newborns: recent advances in the unresolved debate

2020 ◽  
Vol 7 ◽  
pp. 204993612094242
Author(s):  
Guduru Gopal Rao ◽  
Priya Khanna
Keyword(s):  
Risk Factor ◽  
Antimicrobial Resistance ◽  
Low Income ◽  
Streptococcus Agalactiae ◽  
Early Onset ◽  
Group B Streptococcus ◽  
Developed Countries ◽  
Low Income Countries ◽  
Early Onset Sepsis ◽  
Group B

Streptococcus agalactiae, also known as Group B streptococcus (GBS) is the commonest cause of early onset sepsis in newborns in developed high-income countries. Intrapartum antimicrobial (antibiotic) prophylaxis (IAP) is recognized to be highly effective in preventing early onset Group B sepsis (EOGBS) in newborns. The key controversy is about the strategy that should be used to identify mothers who should receive IAP. There are two strategies that are followed in developed countries: screening-based or risk-factor-based identification of women requiring IAP. The debate regarding which of the two approaches is better has intensified in the recent years with concerns about antimicrobial resistance, effect on newborn’s microbiome and other adverse effects. In this review, we have discussed some of the key research papers published in the period 2015–2019 that have addressed the relative merits and disadvantages of screening versus risk-factor-based identification of women requiring IAP. Although screening-based IAP appears to be more efficacious than risk-based IAP, IAP-based prevention has several limitations including ineffectiveness in prevention of late-onset GBS infection in babies, premature and still births, impact of IAP on neonatal microbiota, emergence of antimicrobial resistance and difficulties in implementing IAP-based strategies in middle and low income countries. Alternative strategies, principally maternal immunization against GBS would circumvent use of IAP. However, no licensed vaccines are currently available for use.

scholarly journals DIAGNOSTIC VALUE OF SIMULTANEOUS MEASUREMENT OF PROCALCITONIN, INTERLEUKIN-6 AND HS CRP IN PREDICTION OF EARLY-ONSET NEONATAL SEPSIS

2012 ◽  
Vol 4 (1) ◽  
pp. e2012028 ◽  
Author(s):  
Alireza Abdollahi ◽  
Saeed Shoar ◽  
Fatemeh Nayyeri ◽  
Mamak Shariat
Keyword(s):  
Interleukin 6 ◽  
Simultaneous Measurement ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Clinical Signs ◽  
C Reactive Protein ◽  
Maternal Risk ◽  
Reactive Protein ◽  
Early Onset Sepsis ◽  
Hs Crp

Neonatal sepsis is a major cause of morbidities and mortalities mostly remarkable in the third world nations .We aimed to assess the value of simultaneous measurement of procalcitonin (PCT) and interleukin-6 (IL-6) in association with high sensitive- C reactive protein in prediction of early neonatal sepsis.We performed a follow- up study on 95 neonates who were below 12 hours (h) of age, had clinical signs of sepsis or maternal risk factors for sepsis. Neonates were assigned to 4 groups including “proven early-onset sepsis”, “clinical early-onset sepsis”, “negative infectious status”, and “uncertain infectious status”. Blood samples were obtained within the first 12 h of birth repeated between 24 hours and 36 hours of age for determination of serum levels of PCT, IL-6, high sensitivie- C Reactive Protein (hs-CRP), and white blood cell (WBC) count.On admission, neonates with sepsis had a higher WBC count, IL-6, PCT, and hs-CRP levels compared with those neonates without sepsis. This remained significant even after 12-24 hours of admission. Also, patients with clinical evidences of sepsis had a higher serum level of PCT and IL-6 within 12-24 hours after admission compared to the patients with uncertain sepsis. In final The combination of IL-6, hs-CRP, and PCT seems to be predictive in diagnosis of early onset neonatal sepsis.

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