title: Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use.
abstract: Early diagnosis and timely treatment of early onset neonatal sepsis (EOS) are essential to prevent life threatening complications. Subtle, nonspecific clinical presentation and low predictive values of biomarkers complicate early diagnosis. This uncertainty commonly results in unnecessary and prolonged empiric antibiotic treatment. Annually, approximately 395,000 neonates (7.9% of live term births) are treated for suspected EOS in the European Union, while the incidence of proven EOS varies between 0.01 and 0.53 per 1000 live births. Adherence to guidelines for the management of suspicion of EOS is poor. Pragmatic approaches to minimise overtreatment in neonates with suspected EOS, using combined stratified risk algorithms, based on maternal and perinatal risk factors, clinical characteristics of the neonate and sequential biomarkers are promising.
authors.affiliation: Division of Pediatric Infectious Diseases, Immunology and Rheumatology, Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands. Electronic address: w.vanherk@erasmusmc.nl.
authors.forename: Wendy
authors.initials: W
authors.lastname: van Herk
authors.affiliation: Department of Pediatrics, Division of Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 6000 Luzern 16, Switzerland. Electronic address: martin.stocker@luks.ch.
authors.forename: Martin
authors.initials: M
authors.lastname: Stocker
authors.affiliation: Division of Pediatric Infectious Diseases, Immunology and Rheumatology, Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands. Electronic address: a.vanrossum@erasmusmc.nl.
authors.forename: Annemarie M C
authors.initials: AM
authors.lastname: van Rossum
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D002116:Calcitonin / Q000097:blood; D005062:European Union; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D000071074:Neonatal Sepsis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D000067490:Prescription Drug Overuse / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002116:Calcitonin
keywords: Early onset neonatal sepsis; Guidelines; Neonatal infection; Neonates; Perinatal infections; Procalcitonin; Sepsis