title: Evaluation and Management of Newborns with Suspected Early-Onset Sepsis: Comparison of Two Approaches and Suggestion for Guidelines.
abstract: ObjectiveAlthough its incidence is declining with the widespread use of intrapartum antibiotics, early-onset sepsis (EOS) continues to be associated with high morbidity and mortality. Maternal, infant, and peripartum risk factors, as well as infant's laboratory tests, have been used to try and identify asymptomatic newborns at risk. In this study, we reevaluate the management of newborns at risk for EOS by comparing our outcomes using two different approaches.Study DesignComparison of clinical data and outcomes of newborns at risk for EOS between two study periods, in which we have used two different protocols for their evaluation and management.ResultsAlthough outcomes were not different, adoption of the criteria suggested in the 2012 American Academy of Pediatrics guidelines in the second era resulted in increased utilization of diagnostic laboratory tests and increased use of empiric antibiotic treatments with less yield in a population with a low incidence of EOS (< 0.3/1,000 live births), such as ours.ConclusionIn asymptomatic newborns at risk for EOS, careful assessment of a set of maternal, infant, and peripartum risk factors and their severity combined with careful clinical observation, judicious use of laboratory evaluations, and empiric antibiotic treatment only in selected cases seem to be appropriate.
authors.affiliation: Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Arieh
authors.initials: A
authors.lastname: Riskin
authors.affiliation: Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Aloni
authors.affiliation: Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Kugelman
authors.affiliation: Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Arina
authors.initials: A
authors.lastname: Toropine
authors.affiliation: Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Waseem
authors.initials: W
authors.lastname: Said
authors.affiliation: Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Bader
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D058345:Asymptomatic Infections / Q000628:therapy*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents