Diagnosis Of Early-onset Neonatal Sepsis Research Articles

At Admission Evaluation of the Score for Neonatal Acute Physiology (SNAP II) and Estimation of Serum Procalcitonin Allow Early Diagnosis of Early-Onset Neonatal Sepsis

At Admission Evaluation of the Score for Neonatal Acute Physiology (SNAP II) and Estimation of Serum Procalcitonin Allow Early Diagnosis of Early-Onset Neonatal Sepsis

Cord blood procalcitonin in the assessment of early-onset neonatal sepsis

Abstract Introduction Early diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. Objective To study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. Patients and methods Neonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin ( Results and conclusions Of the 2.519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management.

The Correlation of Fc-gamma Receptor I (CD64) Expression and Procalcitonin in Early Onset Neonatal Sepsis

Objective: The aim of this study is to prove the relationship of FcγRI (CD64) expression and Procalcitonin value in earlyonset neonatal sepsis to assist in diagnosis of early-onset neonatal sepsis. Method: A descriptive and analytical case control study was conducted in dr. Saiful Anwar General Hospital Malang. There were 40 children divided into two groups: 1). Group of infants with neonatal risk factors who express signs of SIRS and proven by blood culture; 2). Group of infants with neonatal risk factors who showed no sign for SIRS. Both groups were performed examination of FcγRI (CD64) expression with flowcytometry and Procalcitonin value with ELISA. Data were statistically analyzed using normality test (Kolmogorov-Smirnov), chi square test, t test and Pearson correlation. We used SPSS 16 for this analysis. Results: The study showed that the FcγRI (CD64) expression and Procalcitonin value were higher in the infants group with proven early-onset neonatal sepsis (p less than 0.05). There was a significant relationship between FcγRI (CD64) expression and the Procalcitonin value (p=0.036). Conclusions: We conclude that expression of FcγRI (CD64) and Procalcitonin value were higher in the infants group with proven early-onset neonatal sepsis. There is a positive relationship between FcγRI (CD64) expression and Procalcitonin value in early onset neonatal sepsis

Procalcitonina en sangre de cordón en la valoración del riesgo de sepsis neonatal precoz

IntroductionEarly diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. ObjectiveTo study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. Patients and methodsNeonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin (< 0.6ng/ml versus ≥0.6ng/ml). They were later classified as proved infection, probable, or no infection. Results and conclusionsOf the 2,519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT<0.6ng/ml in cord blood developed EONS (100% negative predictive value). On the other hand, of the 16 cases with PCT ≥0.6ng/ml, 10 were proven or probably infected (62.5% positive predictive value). The sensitivity of the PCT against infection was 100%, with a specificity of 95.2% (area under the receiver operator curve 0.969). The incidence of infection in the study group was 7.4%, and 26.1% in cases with maternal chorioamnionitis. 21 newborn (15.4%) received antibiotic therapy.The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management.

A comparison of neutrophil gelatinase-associated lipocalin and immature to total neutrophil ratio for diagnosing early-onset neonatal sepsis

Background Neonatal sepsis is a clinical syndrome caused by the invasion of microorganisms into the bloodstream. Early diagnosis of early-onset neonatal sepsis (EONS) is difficult. Laboratory tests with high sensitivity and specificity are needed in order to make early diagnoses in newborns.Objective To compare the sensitivity and specificity of neutrophil gelatinase-associated lipocalin (NGAL) and immature to total (IT) neutrophil ratio for the diagnosis of early-onset neonatal sepsis.Methods This observational study with cross-sectional design was conducted in the Neonatology Division, Prof. R. D. Kandou General Hospital from November 2012 to April 2014. Consecutive sampling was applied. There were 103 newborns with suspected EONS who fulfilled the inclusion criteria. Complete blood counts, blood cultures, as well as NGAL and IT ratio measurements were performed.Results NGAL was not significantly more sensitive than IT ratio [80.4% vs. 67.3%, respectively; (P=0.058)]. However, NGAL had lower specificity than IT ratio (27.7% vs. 50.0%, respectively; P=0.016). The positive predictive values (57.0% vs. 64.9%, respectively; P=0.176), and negative predictive values (54.2% vs. 52.6%, respectively; P=0.451) were similar in both diagnostic tests.Conclusion Immature to total neutrophil (IT) ratio has higher specificity compared to NGAL for early diagnosis of EONS. However, the difference in sensitivity between the two test is not statistically significant.

Inflammatory markers in cord blood or maternal serum for early detection of neonatal sepsis—a systemic review and meta-analysis

To perform a quantitative review of the evidence on the diagnostic value of inflammatory markers in maternal serum or umbilical cord blood for the diagnosis of early-onset neonatal sepsis (EONS). We searched multiple databases for studies published through March 2013 that evaluated the diagnostic performance of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and leukocyte count (white blood cell, WBC) in either umbilical cord blood or maternal serum for diagnosis of EONS. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. Our search identified 3874 citations, of which 15 studies evaluating 2178 episodes of suspected neonatal infection were included for analysis. IL-6 in cord blood with a pooled-positive likelihood ratio (LR+) of 9.47 (95% confidence interval: 3.86 to 23.3), PCT in cord blood with a LR+ of 5.72 (1.56 to 21.0) and IL-6 in maternal serum with a LR+ of 5.47 (2.10 to 14.2) can be qualified as a valid rule-in test. IL-6 in cord blood with a LR- of 0.10 (0.05 to 0.21) and PCT in cord blood with a LR- of 0.20 (0.12-0.37) can be qualified as a useful rule-out test. Either CRP or WBC was inadequate for diagnosis of EONS. For cord blood sample, IL-6 or PCT can be used as reliable rule-in and rule-out tool. For maternal serum, only IL-6 appeared to be sufficient for rule-in diagnosis. An interventional study may be needed to answer whether the addition of these tests will improve the outcome of patients with EONS.

Neutrophil expression of CD64 in the diagnosis of early-onset neonatal sepsis

Objective The aim of the study was to determine the role of CD64 expression as a neutrophil surface marker in the early diagnosis of neonatal sepsis. Background Neonatal sepsis is a life-threatening disease with an incidence of 1-10 per 1000 live births and a mortality rate of 15-50%. The clinical signs are nonspecific and indistinguishable from those caused by a variety of neonatal noninfectious disorders. Patients and methods The studied population comprised 62 neonates with gestational ages of 26-41 weeks who were suspected to have sepsis (poor suckling, fever, vomiting, diarrhea, pallor, tachycardia, and others) in the first 15 days of life, and 18 healthy age and sex-matched neonates. Complete blood count analysis, C-reactive protein determination, blood culture, and flow cytometric analysis of CD64 expression on the neutrophil surface were carried out. Results CD64 expression was significantly higher in the group with sepsis than in the control groups ( P Conclusion A change in cell surface expression of CD64 on peripheral blood neutrophils may be considered a sensitive marker for the detection of neonatal sepsis if used in combination with other laboratory parameters.

Thymic involution as a predictor of early-onset neonatal sepsis

Background: Diagnosis of early-onset neonatal sepsis (EONS) is often difficult because of vague clinical signs and non-specific laboratory parameters.Objective: To assess the statistical validity of thymic size estimation as a diagnostic marker of EONS compared with cord blood interleukin-6 (IL-6) concentrations.Subjects and Methods: Thirty-two neonates delivered in hospital and admitted to the neonatal unit with EONS comprised the study group. EONS was diagnosed on the basis of development of clinical signs and symptoms of sepsis within 72 hours of birth in the presence of antenatal risk factors for chorio-amnionitis and a positive blood culture. Thirty-two gestational age- and gender-matched healthy neonates served as controls. Cord blood IL-6 concentrations were estimated by ELISA. Thymic size was assessed by sonological measurement of thymic dimensions (longitudinal and transverse diameters, thymic volume and thymic index) within 24 hours of birth in the study infants and the controls. Data were analyzed by SPSS 16·0.Results: Thymic size was significantly smaller whereas cord blood IL-6 concentrations were significantly higher (P<0·001) in the sepsis group than in the controls. Sensitivity and specificity of thymic dimensions were comparable to IL-6 concentrations for diagnosing EONS. Significant correlation was noted between reduction in thymic size and a rise in IL-6 concentrations.Conclusion: Thymic involution can be used as a reliable diagnostic marker for EONS.

Umbilical blood biomarkers for predicting early-onset neonatal sepsis

Since the 1990s, finding the most efficient markers or combinations as predictors of early-onset neonatal sepsis has been the hot topic of studies. But there is no review of such biomarkers detected in umbilical blood at birth. By comparing clinical values of common inflammatory markers detected in cord blood shortly after birth, in this study we tried to find the most performing one or the most efficient combination that might be potentially used in birth room, as the earliest predictor of early-onset neonatal sepsis. We searched PubMed and Elsevier's Web of Science for studies evaluating cord blood inflammatory markers in relation to early-onset neonatal sepsis. Among C-reactive protein (CRP), procalcitonin (PCT), IL-6, IL-8, TNF-α and IL-1β, none of them could be used individually to establish or exclude the diagnosis of early-onset neonatal sepsis, but PCT, IL-6 and IL-8 have great superiority to CRP, TNF-α and IL-1β. When combined with other hematological markers and clinical observation, the clinical reliability of PCT, IL-6 and IL-8 could be improved. Prolonging the sample collection time window seems to have a positive effect on the clinical utility of IL-6 and IL-8. More researches focusing on the combination of different umbilical cord biomarkers in different clinical settings are needed to achieve clearer conclusions. Multi-center, large-sized analysis, especially examining groups of cytokines, is also expected.

Statistical validity of interleukin-6 as a biomarker for the diagnosis of early-onset neonatal sepsis

Use of empirical antibiotics in neonates with risk factors of early-onset neonatal sepsis (EOS) is a common practice. A laboratory parameter is needed to help in the accurate diagnosis of EOS to avoid unnecessary use of antibiotics. The aim of this prospective observational cohort study was to compare the statistical validity of cord blood interleukin-6 (IL-6) with conventional sepsis screening as an early diagnostic marker for EOS. Eighty-seven neonates with antenatal risk factors for sepsis were followed up for 72 h for the development of EOS. Cord blood was collected for measurement of IL-6 concentrations. Blood culture and conventional sepsis screening (total leukocyte count, absolute neutrophil count, C-reactive protein and micro-erythrocyte sedimentation rate) were sent for analysis soon after delivery. The study group comprised of symptomatic neonates with positive blood culture (n=36). An equal number of gestational-age matched asymptomatic neonates without risk factor of sepsis served as controls. Statistical validity of IL-6 was compared with sepsis screening parameters as the diagnostic marker for EOS. Gram negative organisms were the predominant cause of EOS. The most commonly isolated organism was &lt;em&gt;Acinetobacter baumanii&lt;/em&gt;. The sensitivity and specificity of IL-6 with a cut-off value of 40.5 pg/mL and area under curve of 0.959 were 92.3 and 90.48%, respectively. In contrast, the sensitivity and specificity of different parameters of sepsis screening ranged from 37.5-68.75% and 47.95-57.35%, respectively. In conclusion, cord blood IL-6 can be used as a highly sensitive and specific early diagnostic marker of EOS at a cut-off concentration of 40.5 pg/mL.

Ecthyma gangrenosum in a premature low-birth-weight newborn

Ecthyma gangrenosum is a well-recognised cutaneous infection in critically ill and immunocompromised patients. It is commonly associated with Pseudomonas aeruginosa septicaemia. Classic lesions of ecthyma gangrenosum comprise deep ulcers with ecchymotic, gangrenous centres, bright red areolae and typical raised, purplish, indurated, rolled-out edges. We report ecthyma gangrenosum in a premature low-birth-weight neonate, delivered at home to a third gravida mother with history of chorioamnionitis. He was admitted to a private hospital on third day of life, with a diagnosis of early-onset neonatal sepsis and received multiple antibiotics over next 22 days. The infant was referred to the paediatrics emergency department of Sir Sunderlal Hospital, Banaras Hindu University in a condition of shock, pneumonitis and generalised sepsis. Two gangrenous ulcers with gray-black eschar were present, one over the neck and another over the back. He was diagnosed as a case of neonatal sepsis with ecthyma gangrenosum. Blood culture revealed growth of Pseudomonas aeruginosa, sensitive only to imipenem. The infant died the day following admission.

Procalcitonin measurement at 24 hours of age may be helpful in the prompt diagnosis of early-onset neonatal sepsis

The clinical signs of early-onset neonatal sepsis (EONS) are nonspecific and indistinguishable from those of noninfectious disorders. The early diagnosis of EONS is difficult, but is essential to improve outcomes. The aim of this study was to determine the diagnostic value of procalcitonin (PCT) at birth and at 24h of age in the prompt diagnosis of EONS. The patient group consisted of neonates with a Töllner score of ≥ 10 or a Töllner score of 5-10 but with the presence of prolonged rupture of the membranes (> 18 h) or chorioamnionitis or maternal fever (n=171). The control group (n=89) comprised neonates admitted to the neonatal intensive care unit for different disease entities. Procalcitonin levels at birth (first) and at 24h of age (second) were measured for each neonate in both of the study groups. There was no difference between the two groups in terms of gender, birth weight, or gestational age. The mean (min-max) first PCT level was 0.48 (0.07-3.48)ng/ml in the controls and 0.51 (0.09-28.6)ng/ml in patients. The mean (min-max) second PCT level was 1.72 (0.21-18.23)ng/ml in the controls and 16.17 (0.17-100)ng/ml in patients. There was no statistically significant difference in PCT levels between the patient and control groups at birth. However, at 24h of age, PCT levels were significantly higher in the patient group than in the control group (p<0.001). Serum PCT levels in controls at 24h of age were slightly increased compared to levels at birth, but as a normal reaction. PCT thresholds for the diagnosis of sepsis were 0.59 ng/ml at birth (sensitivity 48.7%, specificity 68.6%) and 5.38 ng/ml at 24h of life (sensitivity 83.3%, specificity 88.6%). In EONS, PCT measurements at birth may initially be normal; a serial PCT measurement at 24h of age may be more helpful for an early diagnosis. During the first 24h of life PCT is a more sensitive marker of infection than C-reactive protein. Further studies are needed to confirm our findings.

C reactive protein and procalcitonin: Reference intervals for preterm and term newborns during the early neonatal period

BackgroundThere is still no study evaluating the influence of gestational age (GA) per se on C reactive protein (CRP) and procalcitonin (PCT) reference intervals. We therefore investigated how length of gestation, age (hours), and prenatal and perinatal variables might influence the levels of CRP and PCT. We also determined 95% age-specific reference intervals for CRP and PCT in healthy preterm and term babies during the early neonatal period. MethodsOne blood sample (one observation per neonate) was taken for CRP and PCT from each newborn between birth and the first 4 (for term), or 5days (for preterm newborns) of life by using a high-sensitive CRP and PCT assays. ResultsIndependently of gender and sampling time, GA had a significantly positive effect on CRP, and a significantly negative effect on PCT. Compared with healthy term babies, healthy preterm babies had a lower and shorter CRP response, and, conversely, an earlier, higher, and longer PCT response. CRP reference intervals were affected by a number of pro-inflammatory risk factors. ConclusionsAge- and GA-specific reference ranges for both CRP and PCT should be taken into account to optimize their use in the diagnosis of early-onset neonatal sepsis.

The accuracy of the procalcitonin test for the diagnosis of neonatal sepsis: A meta-analysis

A meta-analysis was performed to assess the accuracy of the procalcitonin (PCT) test for diagnosing neonatal sepsis. The major databases, MEDLINE, EMBASE and the Cochrane Library were searched for studies published between January 1996 and May 2009 that evaluated PCT as a diagnostic marker for neonatal sepsis and provided sufficient data to calculate sensitivity and specificity. Twenty-two studies were included in the analysis. Trials that evaluated the PCT test for the diagnosis of early-onset neonatal sepsis at different time points (birth, 0-12 h, 12-24 h, and 24-48 h) and late-onset neonatal sepsis (LONS) all showed moderate accuracy (Q* = 0.79, 0.86, 0.81, 0.82, and 0.77, respectively). The PCT test was more accurate than the C-reactive protein (CRP) test for the diagnosis of LONS. A sensitivity analysis found that differences in PCT assay producer, gestational age and severity of sepsis in the study population may partially explain the between-studies heterogeneity. The PCT test showed moderate accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria and time points for testing. For the diagnosis of LONS, the PCT test showed better accuracy than the CRP test. PCT is a valuable additional tool for the diagnosis of neonatal sepsis.

Does polycythemia affect interleukin‐6 response pattern in early postnatal period?

Neonatal polycythemia may result in increased cytokine production. We aimed to investigate whether polycythemia and partial exchange transfusion (PET) affect interleukin-6 (IL-6) response pattern in early neonatal period. Ninety-four newborns, 57 with polycythemia (Group 1) and 37 as control group (Group 2) were enrolled in the study. PET was performed at 4-6 hr following birth in the first group. Blood levels of IL-6 were measured at 2-4 hr following birth; measurements were repeated at 6 and 24 hr after PET in newborns with polycythemia and at similar hours in Group 2. In Group 1, two patients (3.5%) who were diagnosed with proven sepsis excluded from the study. Both initial and the last IL-6 levels were higher in Group 1 (21.7; 5.5-190 pg/ml and 18.3; 2.7-92.4 pg/ml) than those of the controls (8.4; 0.2-47.8 pg/ml and 8.6; 2.0-21.0 pg/ml) (P=0.001 for both comparisons). In Group 1, IL-6 levels increased at 6 hr after PET and decreased thereafter. IL-6 showed the same pattern in the control group. IL-6 levels were higher than >70 pg/ml in two (3.6%), seven (12.7%), and two (3.6%) subjects during three evaluation steps, respectively. Neither clinical nor proven sepsis was subsequently detected in any of these subjects. IL-6 levels were within the acceptable values in Group 2. IL-6 levels seem to be high in newborns with polycythemia during the first days of life, although they rarely exceed maximum acceptable levels. The pattern of IL-6 response might be taken into account to optimize its use in the diagnosis of early-onset neonatal sepsis.

Characterization of RAGE, HMGB1, and S100β in Inflammation-Induced Preterm Birth and Fetal Tissue Injury

Immune activation represents an adaptive reaction triggered by both noxious exogenous (microbes) and endogenous [high mobility group box-1 protein (HMGB1), S100 calcium binding proteins] inducers of inflammation. Cell stress or necrosis lead the release of HMGB1 and S100 proteins in the extracellular compartment where they act as damage-associated molecular pattern molecules (or alarmins) by engaging the receptor for advanced glycation end-products (RAGE). Although the biology of RAGE is dictated by the accumulation of damage-associated molecular pattern molecules at sites of tissue injury, the role of RAGE in mediating antenatal fetal injury remains unknown. First, we studied the relationships at birth between the intensity of human fetal inflammation and sRAGE (an endogenous RAGE antagonist), HMGB1, and S100beta protein. We found significantly lower sRAGE in human fetuses that mounted robust inflammatory responses. HMGB1 levels correlated significantly with levels of interleukin-6 and S100beta in fetal circulation. We then evaluated the levels and areas of tissue expression of RAGE, HMGB1, and S100beta in specific organs of mouse fetuses on E16. Using an animal model of endotoxin-induced fetal damage and preterm birth, we determined that inflammation induces a significant change in expression of RAGE and HMGB1, but not S100beta, at sites of tissue damage. Our findings indicate that RAGE and HMGB1 may be important mediators of cellular injury in fetuses delivered in the setting of inflammation-induced preterm birth.

176: Diagnosis of early-onset neonatal sepsis in premature neonates from proteomic analysis of umbilical cord blood

176: Diagnosis of early-onset neonatal sepsis in premature neonates from proteomic analysis of umbilical cord blood

Reactive hyperemia and interleukin 6, interleukin 8, and tumor necrosis factor-alpha in the diagnosis of early-onset neonatal sepsis.

To evaluate the diagnostic value of peripheral circulatory reactive hyperemia and serum levels of interleukin-6 (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-alpha) in early-onset neonatal sepsis. Reactive hyperemia in the dorsal hand and serum levels of IL-6, IL-8, and TNF-alpha were studied in newborn infants (n = 32; gestational age 39 +/- 3 weeks) who had been admitted to the neonatal unit because of suspected sepsis <48 hours after birth. On admission, reactive hyperemia after a standardized arterial occlusion was measured with laser Doppler technique, and blood samples were taken for cytokine analyses. On the basis of predetermined criteria, the infants subsequently were classified as septic (n = 12) or not (n = 20). The degree of reactive hyperemia was higher in the group with sepsis (median + 170% perfusion increase) than in that without (+37%). On admission, serum levels of IL-6, IL-8, and TNF-alpha all were higher in septic (median values: 1620, 331, and 22 pg/mL, respectively) than in nonseptic neonates (median values: 42, 63, and 13 pg/mL, respectively). In the group with sepsis, the degree of reactive hyperemia correlated to log IL-6 (r = 0.80) and log IL-8 values (r = 0.71). Newborn infants with septicemia have increased reactive hyperemia and elevated cytokine levels very early in their disease. Reactive hyperemia in skin can be analyzed at the bedside and noninvasively and therefore may serve as an additional diagnostic tool in neonatal sepsis.

Serial Measurements of C-Reactive Protein and Interleukin-6 in the Immediate Postnatal Period: Reference Intervals and Analysis of Maternal and Perinatal Confounders

There is a wide range of reported sensitivities and specificities for C-reactive protein (CRP) and interleukin-6 (IL-6) in the detection of early-onset neonatal infection. This prompted us to assess reference intervals for CRP and IL-6 during the 48-h period immediately after birth and to identify maternal and perinatal factors that may affect them. CRP and IL-6 values were prospectively obtained for 148 healthy babies (113 term, 35 near-term) at birth and at 24 and 48 h of life, and from their mothers at delivery. Upper reference limits for CRP at each neonatal age were established. At birth, CRP was significantly lower than at 24 and 48 h of life. Rupture of membranes > or =18 h, perinatal distress, and gestational hypertension significantly affected the neonatal CRP dynamics, but at specific ages. There was no correlation between CRP concentrations in mothers and their offspring at birth. The IL-6 values observed in the delivering mothers and in their babies at all three neonatal ages were negatively associated with gestational age. In the immediate postnatal period, IL-6 dynamics for term babies were significantly different from those for near-term babies. Maternal IL-6 concentrations correlated with babies' IL-6 concentrations only for term deliveries. Apgar score had a significant effect on babies' IL-6 values at birth. The patterns of CRP and IL-6 responses in the healthy neonate should be taken into account to optimize their use in the diagnosis of early-onset neonatal sepsis.

The influence of intrapartum antibiotic therapy on the diagnosis of early-onset neonatal sepsis

To determine the influence of intrapartum antibiotic therapy on blood and secretion cultures of newborn infants suspected of early-onset sepsis. From August 1995 through July 1996, 69 sequential newborn infants with early-onset sepsis or septic syndrome were included in the study. All of them were followed for the end point: positivity of blood, urine, CSF, tracheal secretion or umbilical catheter cultures. The sample size was figured out to be 17 for each group, for a significant level of 5%. Seventeen mothers were treated with antibiotic. Ampicillin alone or in association with other drugs was utilized in 70% of them. Urinary tract infection occurred in 9 mothers (53%), ammonites in 6, one mother had both and another one had erysipelas. Thirteen newborn infants had positive cultures in the group whose the mothers had not received antibiotic (n=52), none of the 17 newborn infants delivered by the mothers treated with antibiotic had any positive culture (p=0.0164). The relative risk of positive culture in a septic neonate if the mother is not treated with antibiotic is 12 times higher than if the mother is treated with antibiotic. The use of intrapartum antibiotic in newborn infants with early-onset sepsis or septic syndrome may cause a negativity of cultural exams, increasing the difficulty of the diagnosis of early-onset neonatal sepsis.