50 Years Ago in TheJournalofPediatrics: Neonatal Septicemia

Abstract

Gotoff SP, Behrman RE. J Pediatr 1970;76:142-53. Gotoff and Behrman defined neonatal septicemia as generalized bacterial infection documented by positive blood culture in the first 4 weeks of life; it was categorized as early-onset sepsis (EOS) and late-onset sepsis (LOS; after 72 hours). A presumptive diagnosis was based on clinical evidence. Infected amniotic fluid was a major source of neonatal septicemia. The most common organisms causing EOS were Escherichia coli, Streptococcus faecalis, and Staphylococcus aureus; beta hemolytic streptococci were also reported. Organisms isolated in LOS included Pseudomonas, Proteus, Klebsiella-Aerobacter, and S aureus. First-line antibiotic therapy for EOS and LOS were ampicillin plus kanamycin and methicillin/oxacillin plus kanamycin, respectively, for 7-10 days. Whole blood as a plasma expander, injection sodium bicarbonate injection, and glucose infusion were being given for shock. Hydrocortisone injection and isoproterenol infusion as vasopressors were indicated in nonresponders. Intravascular coagulation was managed with fresh heparinized whole blood and heparin injection. Fifty years later, neonatal sepsis remains the third-leading global cause of death under age 5 years. The subdivision into EOS and LOS is now universally accepted. The major causative organisms for EOS in developed countries are group B streptococci and E coli. More than 50% of cases of LOS are caused by coagulase-negative staphylococci (CONS), and the remainder are caused by gram-negative organisms. In developing countries, common organisms causing neonatal sepsis include S aureus, E coli, and Klebsiella species. Absolute neutrophil count, C-reactive protein, and procalcitonin are increasingly being used to support the diagnosis. Urine culture, gastric aspirate examination, and body surface cultures are not routinely recommended. Today, first-line antibiotics for EOS are ampicillin/benzyl penicillin plus aminoglycoside (gentamicin) for 7-10 days. For LOS, combinations of third-generation cephalosporins plus aminoglycoside, ampicillin plus gentamicin, or vancomycin/flucloxacillin plus gentamicin/cefotaxime are recommended, based on local resistance patterns and whether hospital-acquired or community-acquired.1World Health Organization Antibiotic use for sepsis in neonates and children: 2016 evidence update.https://www.who.int/selection_medicines/committees/expert/21/applications/s6_paed_antibiotics_appendix4_sepsis.pdfDate accessed: July 6, 2019Google Scholar, 2Clinical Excellence CommissionNewborn antibiotic guideline for early- and late-onset sepsis during birth episode of care.http://www.cec.health.nsw.gov.au/data/assets/pdf_file/0009/348597/Newborn-Antibiotic-Guide∼or-early-and-late-onset-sepsis-during-birth-episode-of-care-Revised-June-2018.pdfDate: 2018Date accessed: July 3, 2019Google Scholar Treatment is given for 7-10 days except for meningitis, which is treated for 21 days. Fresh-frozen plasma is recommended for intravascular coagulation. Newer therapies in the pipeline include immunoglobulins, colony-stimulating factors, anti–tumor necrosis factor, and interleukin antagonists.