title: Early-onset Sepsis and Antibiotic Exposure in Term Infants: A Nationwide Population-based Study in Norway.
abstract: BACKGROUND
  Sepsis is a leading cause of neonatal morbidity and mortality. Clinical suspicion may lead to overuse of antibiotics. The objective of this study was to assess the epidemiology of early-onset sepsis (EOS) and antibiotic exposure during the first week of life in Norwegian term infants.
  
  
  METHODS
  This is a nationwide population-based study from the Norwegian Neonatal Network. During the 3-year study period (2009-2011), 20 of Norway's 21 neonatal units prospectively collected data. Among 168,877 live-born (LB) term infants born during the study period, 10,175 (6.0%) infants were hospitalized in the first week of life and included in the study.
  
  
  RESULTS
  There were 91 cases of culture-confirmed EOS (0.54 per 1000 LB) and 1447 cases classified as culture-negative EOS (8.57 per 1000 LB). The majority of culture-confirmed EOS cases were caused by Gram-positives (83/91; 91%), most commonly group B streptococci (0.31 per 1000 LB). Intravenous antibiotics were administered to 3964 infants; 39% of all admissions and 2.3% of all LB term infants. Empiric therapy consisted of an aminoglycoside and either benzylpenicillin or ampicillin in 95% of the cases. The median (interquartile range) treatment duration was 8 (7-10) days for culture-confirmed EOS and 6 (5-7) days for culture-negative EOS. There was 1 EOS-attributable death (group B streptococcal EOS) during the study period.
  
  
  CONCLUSIONS
  In this registry-based study, the incidence of culture-confirmed EOS was in line with previous international reports and the mortality was very low. A large proportion of infants without infection were treated with antibiotics. Measures should be taken to spare neonates unnecessary antibiotic treatment.
authors.affiliation: From the *Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway; †Women and Children's Clinic, Neonatal Intensive Care Unit, Oslo University Hospital, Oslo, Norway; ‡Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway; §Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; ¶Department of Microbiology and Infection Control, University Hospital North Norway, Tromsø, Norway; ‖Research Group for Host-Microbe Interaction, Institute of Medical Biology, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway; **Department of Paediatrics, Haukeland University Hospital, Bergen, Norway; and ††Department of Paediatrics and Adolescence Medicine, University Hospital North Norway, Tromsø, Norway.
authors.forename: Jon W
authors.initials: JW
authors.lastname: Fjalstad
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Stensvold
authors.forename: Håkon
authors.initials: H
authors.lastname: Bergseng
authors.forename: Gunnar S
authors.initials: GS
authors.lastname: Simonsen
authors.forename: Bodil
authors.initials: B
authors.lastname: Salvesen
authors.forename: Arild E
authors.initials: AE
authors.lastname: Rønnestad
authors.forename: Claus
authors.initials: C
authors.lastname: Klingenberg
mesh_terms: D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance; D012042:Registries; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents