title: Safety of physical examination alone for managing well-appearing neonates ≥ 35 weeks' gestation at risk for early-onset sepsis.
abstract: OBJECTIVE
  The published data to support recommendations for prevention and management of well-appearing at-risk newborns (WAARNs) for early-onset sepsis (EOS) are limited.
  
  
  METHODS
  Retrospective cohort study comparing two different strategies for managing WAARNs (≥ 35 weeks' gestation) during a 6-year period (Period 1, from 2005 to 2007; Period 2, from 2009 to 2011). WAARNs were defined as healthy-appearing neonates evaluated because of risk factors for EOS. Laboratory evaluation plus simplified physical examination (Period 1) was compared with physical examination alone (PEA, Period 2). The use of antibiotics, the length of stay, the timeliness of diagnosis and the risk of falling ill immediately after hospital discharge in both periods were also compared.
  
  
  RESULTS
  WAARNs receiving empirical antibiotics were 14/500 (Period 1) and 3/500 (Period 2, p = 0.01). Median length of stay was 4 (Period 1) and 3 days (Period 2, p = 0.04). Symptoms of EOS were earlier than laboratory evaluation results in 42/44 neonates. Severe disease was diagnosed within 6 h of life in all neonates. No WAARNs presented with EOS following hospital discharge.
  
  
  CONCLUSIONS
  WAARNs managed through PEA received less unnecessary antibiotics and had a shorter length of stay. They had no increased risk of severe complications or increased risk of becoming ill following hospital discharge.
authors.affiliation: a Unità Operativa di Terapia Intensiva Neonatale , Azienda Ospedaliero - Universitaria Policlinico , Modena , Italy .
authors.forename: Alberto
authors.initials: A
authors.lastname: Berardi
authors.forename: Sara
authors.initials: S
authors.lastname: Fornaciari
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rossi
authors.forename: Viviana
authors.initials: V
authors.lastname: Patianna
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.forename: Filippo
authors.initials: F
authors.lastname: Ferrari
authors.forename: Isabella
authors.initials: I
authors.lastname: Neri
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ferrari
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010808:Physical Examination / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents
keywords: Group B Streptococcus; intrapartum antibiotic prophylaxis; management; neonatal sepsis; prevention