Document Detail


Management of neonates with suspected or proven early-onset bacterial sepsis.
MedLine Citation:
PMID:  22547779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
With improved obstetrical management and evidence-based use of intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. The identification of neonates at risk for early-onset sepsis is frequently based on a constellation of perinatal risk factors that are neither sensitive nor specific. Furthermore, diagnostic tests for neonatal sepsis have a poor positive predictive accuracy. As a result, clinicians often treat well-appearing infants for extended periods of time, even when bacterial cultures are negative. The optimal treatment of infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identified, antimicrobial therapy should be narrowed (unless synergism is needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (≥5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis, and mortality. To reduce these risks, antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low. The purpose of this clinical report is to provide a practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis.
Authors:
Richard A Polin;
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Publication Detail:
Type:  Journal Article     Date:  2012-04-30
Journal Detail:
Title:  Pediatrics     Volume:  129     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-02     Completed Date:  2012-06-21     Revised Date:  2012-12-03    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1006-15     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / adverse effects,  therapeutic use*
Bacteremia / diagnosis,  drug therapy*,  etiology
Bacteriological Techniques
Cooperative Behavior
Drug Administration Schedule
Evidence-Based Medicine
Female
Gestational Age
Humans
Infant, Newborn
Infant, Premature, Diseases / drug therapy*
Interdisciplinary Communication
Microbial Sensitivity Tests
Pregnancy
Risk Factors
Sepsis / diagnosis,  etiology,  therapy*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Investigator
Investigator/Affiliation:
Lu-Ann Papile / ; Jill E Baley / ; William Benitz / ; Waldemar A Carlo / ; James Cummings / ; Praveen Kumar / ; Richard A Polin / ; Rosemarie C Tan / ; Kasper S Wang / ; Kristi L Watterberg /
Comments/Corrections
Comment In:
Pediatrics. 2012 Oct;130(4):e1052-3; author reply e1055-7   [PMID:  23035239 ]
Pediatrics. 2012 Oct;130(4):e1055; author reply e1055-7   [PMID:  23035242 ]
Pediatrics. 2012 Oct;130(4):e1053-4; author reply e1055-7   [PMID:  23035240 ]
Pediatrics. 2012 Oct;130(4):e1054-5; author reply e1055-7   [PMID:  23035241 ]

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


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