Document Detail

Limitations of the risk factor based approach in early neonatal sepsis evaluations.
MedLine Citation:
PMID:  22937988     Owner:  NLM     Status:  MEDLINE    
AIM: Guidelines for detection of early neonatal sepsis employ a risk factor approach combined with laboratory parameters. In an era of increasing intrapartum antibiotic prophylaxis (IAP), we re-assessed the approach as a whole and each of the risk factors individually.
METHOD: This retrospective study included infants with risk factors for sepsis or those treated with antibiotics or who had documented early sepsis. Safety of the protocol was assessed by the number of cases of either missed or partially treated late sepsis or meningitis and the sepsis-related mortality rate. Predictive value of each clinical and laboratory factor was calculated.
RESULTS: Of the 22,215 neonates, 2096 were assessed. IAP among infants with risk factors rose from 68% in 2005 to 78% in 2008 (p = 0.001). A total of 1662 asymptomatic infants had risk factors, 635 received antibiotics and one (0.06%) had sepsis. A total of 434 symptomatic infants were treated with antibiotics and of these 234 had risk factors and 20 (4.6%) had sepsis. No cases of partially treated or missed sepsis were detected. Poor predictive value was found for all risk factors except prematurity and leukopenia.
CONCLUSION: The risk factor based approach in asymptomatic infants cannot be justified. In-hospital observation of asymptomatic infants for 2-3 days with antibiotic treatment being reserved only for symptomatic infants may be a reasonable alternative.
Orna Flidel-Rimon; Sophie Galstyan; Ada Juster-Reicher; Ilya Rozin; Eric S Shinwell
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Publication Detail:
Type:  Journal Article     Date:  2012-10-12
Journal Detail:
Title:  Acta paediatrica (Oslo, Norway : 1992)     Volume:  101     ISSN:  1651-2227     ISO Abbreviation:  Acta Paediatr.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  2013-04-25     Revised Date:  2013-08-22    
Medline Journal Info:
Nlm Unique ID:  9205968     Medline TA:  Acta Paediatr     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  e540-4     Citation Subset:  IM    
Copyright Information:
© 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.
Department of Neonatology, Kaplan Medical Center, Rehovot, Affiliated to the Hebrew University, Jerusalem, Israel.
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MeSH Terms
Antibiotic Prophylaxis
Guideline Adherence
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / diagnosis*,  mortality
Israel / epidemiology
Neonatal Screening
Predictive Value of Tests
Retrospective Studies
Risk Factors
Sepsis / diagnosis*,  mortality
Erratum In:
Acta Paediatr. 2013 Aug;102(8):840

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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