Early-onset Neonatal Sepsis Research Articles

142. Impact of an Antimicrobial Stewardship Intervention on Antibiotic Prescribing in Patients with Obstetric Infection and Penicillin Allergy

BackgroundAntibiotics are commonly administered in the peripartum period and most patients with penicillin allergy can tolerate beta lactams, which are preferred for the prophylaxis and treatment of several common obstetric infections. The purpose of this study was to evaluate the impact of a stewardship intervention bundle (including updates to institutional antibiotic guidelines, reclassification of severe penicillin allergy, development of order sets, and a physician champion) on the management of obstetric infections in patients with reported penicillin allergy. MethodsThis was a multicenter, retrospective study of adult patients presenting for labor and delivery who received at least one dose of antibiotics for an infectious indication May 1, 2018 to October 31, 2018 (pre-intervention) and May 1 2020 to October 31, 2020 (post-intervention). The primary outcome was the composite rates of patients with a reported penicillin allergy who received a preferred agent for Group B Streptococcus (GBS) prophylaxis, intraamniotic infection, or cesarean surgical site infection (SSI) prophylaxis. ResultsA total of 192 patients with a documented penicillin allergy were evaluated (96 patients each in pre- and post-intervention groups). Hives were the most commonly reported allergy in both groups (40% vs 39%, P=0.883). Following stewardship interventions, there was a significant increase in the rate of preferred antibiotics prescribed to patients with penicillin allergy (34.3% vs 84.3%, P< 0.001), driven mainly by patients with non-severe allergy (18.4% vs 82.9%, P< 0.001). There were non-statistically significant trends toward lower rates of postpartum endometritis, 30-day readmission, 90-day SSI, and neonatal early onset sepsis. Allergic reactions in the post-intervention group were limited to itching and rash in one patient each; both resolved with medical management. ConclusionA comprehensive antibiotic stewardship intervention increased preferred antibiotic prescribing for treatment and prophylaxis of obstetric infections. Pregnant patients with non-severe penicillin allergies, even those reporting hives, can tolerate beta-lactam antibiotics. The potential positive impact on clinical outcomes warrants additional investigation. Disclosures Neil Seligman, MD, Natera (Consultant)UpToDate (Other Financial or Material Support, Author)

Early-Onset Neonatal Sepsis: Role of C-Reactive Protein, Micro-ESR, and Gastric Aspirate for Polymorphs as Screening Markers.

Introduction Early-onset neonatal sepsis is a major cause of morbidness and death in newborn children. Its timely diagnosis is usually a challenge in developing countries like India. Aim To study the efficacy of C-reactive protein (CRP), micro-ESR, and gastric aspirate for polymorphs in the diagnosis of early-onset neonatal sepsis. Materials and Methods This study included sixty term and preterm children, inborn and referred cases. The children who presented before day seven of life with clinical suspicion of sepsis or who were at high risk of developing sepsis were included. These were further investigated. Significant values for screening tests were taken as C − reactive protein > 0.6 mg/dl, micro-ESR—after 1 hour, fall in the column of blood in capillary tube was measured, and result was taken as mm fall in 1 hr, and gastric aspirate for polymorphs > 5 polymorphs/HPF. Sepsis screen positive result was 2 or more positive tests. The statistical evaluation was done using Fisher, and ANOVA tests using SPSS 20.0 version. Results Sixty children were included in the study with forty as the referred ones. Most of them had tachypnea (45%). CRP showed high sensitivity, whereas micro-ESR and gastric aspirate for polymorphs showed high specificity. Conclusions Neonatal sepsis screening is required for the detection of infection as the blood culture report may not be positive in all the cases, and even if positive, the result takes few hours. CRP showed high sensitivity, whereas micro-ESR and gastric aspirate for polymorphs showed high specificity independently as well as when combined.

Use of umbilical cord blood culture in the diagnosis of early onset neonatal sepsis among high risk mothers

Background: Early onset neonatal sepsis (EONS) is one of the important causes of morbidity and mortality in neonates. Its early diagnosis and prompt treatment is essential and any delay in the diagnosis can have serious consequences including neonatal death. Blood culture is the gold standard test for diagnosis of neonatal sepsis. Umbilical cord blood culture (UCBC) is a painless procedure and technically less challenging. We conducted this study to evaluate use of UCBC for the diagnosis of EONS and compared it with the results of peripheral venous blood culture (PVBC) reports. Aims and Objectives: The aim of the study was to evaluate UCBC for the diagnosis of EONS and compared it with the results of PVBC reports. Materials and Methods: This was a hospital-based prospective cohort study consisting of 100 neonates who were at risk of EONS. The study was conducted in the Department of Pediatrics Sikkim Manipal Institute of Medical Sciences Gangtok between January 2018 and December 2019. Neonates found to be at risk of development of EONS were included in this study on the basis of a predefined inclusion and exclusion criteria. Immediately after birth blood samples were collected from both umbilical cord and peripheral vein and were sent to bacteriology lab. Sensitivity, specificity, positive predictive value, and negative predictive value of both the samples were analyzed. Results: Out of 100 neonates in 32 (32%) EONS could be confirmed with positive sepsis screening results and/or demonstration of organisms on blood culture. Among the 32 neonates with EONS, 17 were found to be premature. The mean gestational age of newborns with EONS was found to be 35.2 weeks. The umbilical blood culture was found to have sensitivity and specificity of 100% and 74.4%, respectively, whereas peripheral vein blood culture was found to have sensitivity and specificity of 77.7% and 72.5%, respectively. The most common organism grown in our study was Escherichia coli. Conclusion: UCBC is painless and technically less challenging method of blood sampling. It has been found to have a higher sensitivity as well specificity for the diagnosis of EONS as compared to peripheral venous blood sample.

Bacteria profiles and risk factors for proven early-onset sepsis in preterm neonates.

Objectives:To fill this gap in the literature and establish a prediction model.Methods:This retrospective study was conducted in a Neonatal Intensive Care Unit between April 2018 and April 2019. Sixty-five sepsis cases were clinically diagnosed with early-onset neonatal sepsis (EONS) and confirmed by bacterial culture, and 91 newborns were enrolled as control. Multivariate analysis was used to analyze the data, and the predictive efficiency of the prediction model was verified using the Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve.Results:There were differences in multiple gestation birth, cesarean section, gestational age, birth weight, Apgar scores at 1 and 5 minutes, and laboratory parameters including white blood cells, neutrophils, lymphocytes, platelets, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) between the groups. Multivariable logistic analysis showed that the Apgar score at 5 minutes and CRP, PCT, and IL-6 levels remained independent significant predictors of EONS (p=0.002, p=0.020, p=0.002, p=0.021, respectively). According to multivariate logistic regression analysis, the risk prediction model was logit p=24.280–3.270 x Apgar score at 5 minutes + 1.396 x CRP + 3.409 x PCT + 0.034 x IL-6 (Lemeshow goodness-of-fit test p=0.143). Receiver operating characteristic curve analysis indicated that the area under the curve was 0.968 (95% confidence interval: 0.936–1.000, p<0.05), and the sensitivity was 90.8% and specificity was 97.8%.Conclusion:The Apgar score at 5 minutes and CRP, PCT, and IL-6 levels are risk factors for EONS. The risk prediction model is highly efficient in predicting EONS among preterm infants.

Increased Levels of Plasma Extracellular Heat-Shock Proteins 60 and 70 kDa Characterized Early-Onset Neonatal Sepsis.

Background: Extracellular heat-shock proteins (eHsp) are highly conserved molecules that play an important role in inflammatory diseases and have been quantified in plasma from patients with infectious diseases, including sepsis. There is a constant search for dependable biochemical markers that, in combination with conventional methods, could deliver a prompt and reliable diagnosis of early-onset neonatal sepsis.Objective: We sought to assess the level of eHsp-27, eHsp-60, eHsp-70, and tumor necrosis factor-alpha (TNFα) in plasma of healthy neonates at term and infants with early-onset neonatal sepsis.Methods: This study included 34 newborns that were classified as healthy neonates at term (blood samples from the umbilical cord, n = 23) or infants with early-onset neonatal sepsis (blood samples obtained from umbilical artery by standard sterile procedures before starting a systemic antibiotic intervention, n = 11). All blood samples were centrifuged, and the plasma recovered to determine eHsp-27, eHsp-60, eHsp-70, and TNFα levels by ELISA.Results: Our results indicate that the level of eHsp-27 in healthy neonates at term was 0.045 ± 0.024 pg/ml. This value decreased 2.5-fold in infants with early-onset neonate sepsis (0.019 ± 0.006 pg/ml, p = 0.004). In contrast, the levels of eHsp-60 and eHsp-70 in healthy neonates at term were 13.69 ± 5.3 and 4.03 ± 2.6 pg/ml, respectively. These protein levels increased significantly 1.8- and 1.9-fold in the plasma of infants with early-onset neonatal sepsis (p ≤ 0.001). The level of TNFα in healthy neonates at term was 2.94 ± 0.46 pg/ml, with a 3.0-fold increase in infants with early-onset neonatal sepsis (8.96 ± 0.72 pm/ml, p ≤ 0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of eHsp compared with that of C-reactive protein were 73.3, 60.0, 47.8, and 33.3%, respectively.Conclusion: This study demonstrated a consistent increase of eHsp-60 and eHsp-70 in the plasma of infants diagnosed with early-onset neonatal sepsis. These proteins showed higher sensitivity and specificity than C-reactive protein and blood culture test.

Use of Two Complementary Bioinformatic Approaches to Identify Differentially Methylated Regions in Neonatal Sepsis

Background: Neonatal sepsis is a heterogeneous condition affecting preterm infants whose underlying mechanisms remain unknown. The analysis of changes in the DNA methylation pattern can contribute to improving the understanding of molecular pathways underlying disease pathophysiology. Methylation EPIC 850K BeadChip technology is an excellent tool for genome-wide methylation analyses and the detection of differentially methylated regions (DMRs). Objective: The aim is to identify DNA methylation traits in complex diseases, such as neonatal sepsis, using data from Methylation EPIC 850K BeadChip arrays. Methods: Two different bioinformatic methods, DMRcate (a supervised approach) and mCSEA (an unsupervised approach), were used to identify DMRs using EPIC data from leukocytes of neonatal septic patients. Here, we describe with detail the implementation of both methods as well as their applicability, briefly discussing the results obtained for neonatal sepsis. Results: Differences in methylation levels were observed in neonatal sepsis patients. Moreover, differences were identified between the two subsets of the disease: Early-Onset neonatal Sepsis (EOS) and Late-Onset Neonatal Sepsis (LOS). Conclusion: This approach by using DMRcate and mCSA helped us to gain insight into the intricate mechanisms that may drive EOS and LOS development and progression in newborns.

Role of Serum Apelin in the Diagnosis of Early-Onset Neonatal Sepsis.

Objective:Apelin is a proinflammatory adipocyte-derived factor. The aim of this study was to evaluate the role and significance of serum apelin as a new sepsis marker in the identification of full-term and preterm new-born infants with early-onset sepsis.Material and Methods:This was a case-control study. We included 80 neonates. The cases were divided into 2 groups; neonates with early-onset sepsis and control group with neonates non-sepsis. Apelin was quantified by enzyme-linked immunosorbent assay.Results:There was a significant elevation in the mean values of serum apelin in the early-onset sepsis group (1214.7 ± 273.06 pg/mmol) than in the non-septic neonates 116.27 ± 21.96 pg/mmol (P < .0001). Apelin values were correlated to clinical sepsis and hematological scores as well as C-reactive protein. Serum apelin concentration was significantly higher among culture-positive cases than the culture-negative cases (mean ± SD was 1239.52 ± 268.47 and 929.42 ± 136.97 pg/mmol, respectively, P < .0001). Moreover, the apelin level was higher in non-survivor neonates than in the survivors in the early-onset sepsis group. No significant difference was found between preterm and full-term new-born infants with regard to the apelin values. The best cut-off estimate of apelin to diagnose early sepsis was >178.33 pg/mmol.Conclusion:Apelin may be useful in the diagnosis and prognostic prediction of neonates with early-onset sepsis.

Neonatal septicemia and current scenario of antibiotic sensitivity pattern – A study of blood culture isolates in a tertiary care hospital, Rajkot

Neonatal sepsis is one of the leading causes of neonatal mortality in developing countries. Neonatal sepsis can be classified into two subtypes depending upon onset of symptoms- before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). Bacteriological profile and antibiotic susceptibility pattern in neonatal septicemia are changing time-to-time and place-to-place. This study is aimed to know the current scenario of neonatal septicemia and antibiotic susceptibility pattern for determining effective treatment, hence reducing burden of antibiotic resistance.This is a Retrospective study. Data was collected from Bacteriology lab, PDUMC Rajkot (May 2020 – May 2021). Blood cultures were performed on suspected neonates. Both BACTEC and conventional methods were used. Organisms were isolated by standard microbiological protocols and antibiotic sensitivity was performed by Kirby-Bauer disc diffusion method as per CLSI- 2020/2021 guidelines. Total 1402 samples were screened. 326 were positive (23.25%). 214(65.64%) were male and 112(34.36%) were female. CONS (32.21%) was found to be the predominant pathogen followed by Klebsiella (19.63%), Staphylococcus aureus (18.10%), E. coli (15.95%), Acinetobacter (12.27%) and Enterococcus spp. (1.84%). EONS was seen in 195(59.82%) cases and LONS was seen in 131(40.18%) cases. Gram-negative bacteria are predominant in EONS (76.28%) and gram-positive bacteria is predominant in LONS (64.12%). Gram negative isolates are mostly susceptible to Meropenem, Piperacillin-tazobactam, Cefepime, Ceftazidime. Gram positive isolates mostly showed sensitivity to Vancomycin, Linezolid.Multi-drug resistant organism are emerging in neonatal septicemia. Strict antibiotic stewardship should be practiced to avoid the upcoming treatment difficulties.

Early-Onset Neonatal Sepsis: A Retrospective Study among 1,119 Moroccan Newborns Admitted to the National Reference Center in Neonatology and Nutrition, Rabat, Morocco

Background Early-onset neonatal sepsis is recognized as a common and serious problem for neonates. The clinical manifestations of neonatal sepsis are nonspecific and have varied clinical features. Therefore, their diagnosis is based on a combination of clinical presentation, the use of biological tests, and anamnestic arguments. The present study aimed to describe the infection risk factors, as well as clinical, paraclinical, and evolutionary characteristics of newborns with suspected early-onset neonatal sepsis and highlight the importance of C-reactive protein(CRP) to diagnose neonatal sepsis.Methods This retrospective analytical study was conducted at the National Reference Center for Neonatology and Nutrition at Children's Hospital, University Hospital Centre IbnSina of Rabat, from January 1 to December 31, 2016.Results During the study period, 1,199 newborns met the inclusion criteria. Upon admission, 52% of cases were under the age of one day. Symptomatic newborns represented 67.4% of the cases. The hospitalized cases with one or more infection risk factors were represented 80.3% of cases. The CRP was positive (> 20 mg/L) in 698 (58%) newborns. Univariate analysis pointed out that CRP value was significantly associated with age groups (P<0.001), presence of at least one infectious risk factor (P<0.001), as well as the presence of respiratory (P<0.001), cutaneous (P<0.001), circulatory (P=0.02), and neurological (P=0.008) symptoms. The diagnosis of early-onset neonatal infection with a meningeal, pulmonary, or ocular location was retained in 5%, 2%, and 0.2% of cases, respectively. The mortality rate was reported as 7%.Conclusion Screening, management, and reduction of early-onset neonatal infection remain a crucial challenge, requiring coordination between pediatricians and obstetricians to obtain reliable data and identify newborns at risk.

Umbilical cord blood culture in neonatal early-onset sepsis: a systematic review and meta-analysis.

Peripheral blood culture (PBC) is considered the gold standard for diagnosis of neonatal early-onset sepsis (EOS), but its diagnostic value can be questioned. We aimed to systematically asses the diagnostic test accuracy (DTA) of umbilical cord blood culture (UCBC) for EOS. A systematic literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Library. Studies performing UCBC for the diagnosis of EOS were included. A total of 1908 articles were screened of which 17 were included. Incidences of positive PBC and UCBC were low in all studies. There was a large heterogeneity in the consistency between positive PBC and UCBC outcomes. PBC had a pooled sensitivity of 20.4% (95% CI 0.0-40.9) and specificity of 100.0% (95% CI 100.0-100.0) compared to 42.6% (95% CI 12.7-72.4%) and 97.8% (95% CI 93.1-100.0) of UCBC for clinical EOS, defined as clinical sepsis regardless of PBC outcomes. This systematic review shows that, compared to PBC, UCBC has higher sensitivity and comparable specificity for clinical EOS and might be considered as diagnostic test for EOS. Due to the limited number of studies, low incidences of EOS cases, and the imperfect reference standards for EOS, results should be interpreted cautiously. This is the first systematic review and meta-analysis investigating the diagnostic test accuracy of umbilical cord blood culture for neonatal early-onset sepsis. Peripheral blood culture is considered the gold standard for diagnosis of neonatal early-onset sepsis, but its value for this specific diagnosis can be questioned. Umbilical cord blood culture has higher sensitivity and comparable specificity for diagnosis of neonatal early-onset sepsis compared to peripheral blood culture, circumventing the risk for iatrogenic anemia and consequently might be used as a diagnostic tool for early-onset sepsis. Quality of evidence was regarded as low due to imperfect diagnostic methods of neonatal early-onset sepsis.

Neonatal sepsis in Sana\u2019a city, Yemen: a predominance of Burkholderia cepacia

BackgroundNeonatal sepsis is a global concern with increasing morbidity and mortality. The burden of neonatal sepsis is highest in developing countries, especially in those lacking proper surveillance systems. The causative pathogens and their drug-resistance levels vary between countries with emergence of multidrug resistance organisms. Thus, accurate records on the recent trends of organisms causing neonatal sepsis will provide vital information for appropriate intervention. We aimed to investigate neonatal sepsis, identify its associated factors and causative pathogens and to assess the antibiotic susceptibility patterns in Sana’a city, Yemen.MethodsA cross-sectional study was conducted on neonates admitted to intensive care units of six hospitals in Sana’a city, Yemen, in the period from January 15, to March 30, 2020. Natal and prenatal medical data were collected using well-structured questionnaire. Neonates were subjected to sepsis work-up including blood culture, complete blood count and C-reactive protein. Organisms were identified by Gram staining and analyzed by the VITEK II system for bacterial bio-typing and antibiotic susceptibility testing.FindingsOf the 199-neonates with suspected neonatal sepsis, 154 (77.38%) had culture-proven sepsis. Early-onset neonatal sepsis (EOS) was higher (50.25%; 100/199) than late-onset neonatal sepsis (LOS) (27.13%; 54/199). Multivariable analysis identified vaginal delivery as an independent risk factor for neonatal sepsis p = 0.005. Majority of isolated bacteria (74.39%) were gram-negative with Burkholderia cepacia (39%) and Klebsiella oxytoca (13%) being the most common pathogens of EOS and LOS. The most common gram-positive pathogens were Staphylococcus haemolyticus (9.1%) and Staphylococcus epidermidis (7.1%). B. cepacia showed multidrug resistance except for cefepime. All Klebsiella species isolates (100%) and most Pantoea species (93%) were ESBL and carbapenemase positive. All Escherichia coli and Acinetobacter baumannii isolates were ESBL positive. A significant number of gram-positive bacteria showed resistance to vancomycin.ConclusionThe study findings show a high proportion of neonatal sepsis among neonates admitted to hospitals in Sana’a city with antibiotic-resistant B. cepacia being the single most common pathogen causing EOS and LOS. Findings also emphasize the emerging threat of multidrug-resistant bacteria in neonatal units and will help develop evidence-based management of neonatal sepsis in Yemen.

50 Years Ago in TheJournalofPediatrics: Early-Onset Neonatal Sepsis

50 Years Ago in TheJournalofPediatrics: Early-Onset Neonatal Sepsis

Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates

BackgroundsThe large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age.MethodsData from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used. We performed a cost-minimization study of health care costs, comparing standard care to PCT-guided decision making.ResultsIn total, 1489 neonates were included in the study, of which 754 were treated according to PCT-guided decision making and 735 received standard care. Mean health care costs of PCT-guided decision making were not significantly different from costs of standard care (€3649 vs. €3616). Considering subgroups, we found a significant reduction in health care costs of PCT-guided decision making for risk category ‘infection unlikely’ and for gestational age ≥ 37 weeks in the Netherlands, Switzerland and the Czech Republic, and for gestational age < 37 weeks in the Czech Republic.ConclusionsHealth care costs of PCT-guided decision making of term and late-preterm neonates with suspected EOS are not significantly different from costs of standard care. Significant cost reduction was found for risk category ‘infection unlikely,’ and is affected by both the price of PCT-testing and (prolonged) hospitalization due to SAEs.

Potential benefit from the implementation of the Kaiser Permanente neonatal early-onset sepsis calculator on clinical management of neonates with presumed sepsis.

To assess the potential benefit from the implementation of the Kaiser Permanente early-onset sepsis calculator (EOS-C), in terms of antibiotic use and requested laboratory tests, in a network of neonatal intensive care units (NICUs) in Greece, and to determine the incidence of early-onset sepsis (EOS) in Greek NICUs, a prospective surveillance study was conducted in 7 NICUs between April 2018 and June 2019. Data were collected for all newborns ≥ 34weeks' gestation receiving empiric antibiotic therapy within the first 3days of life. The number of live births and positive blood or cerebrospinal fluid cultures within the first 3days of life were used for calculation of EOS incidence. Evaluation of possible impact of implementing the calculator was done by comparing the clinicians' recorded management to the calculator's suggested course of action. The unit-specific incidence of culture-proven EOS ranged between 0 and 2.99/1000 live births. The weighted incidence rate for all 7 units was 1.8/1000 live births. Management of EOS guided by the calculator could lead to a reduction of empiric antibiotic initiation up to 100% for the group of "well-appearing" neonates and 86% for "equivocal," lowering exposure to antibiotics by 4.2 and 3.8days per neonate, respectively. Laboratory tests for blood cultures drawn could be reduced by up to 100% and 68%, respectively. Sensitivity of the EOS-C in identifying neonates with positive blood cultures was high.Conclusion: Management strategies based on the Kaiser Permanente neonatal sepsis calculator may significantly reduce antibiotic exposure, invasive diagnostic procedures, and hospitalizations in late preterm and term neonates. What is Known: • Neonates are frequently exposed to antibiotics for presumed EOS. • The Kaiser Permanente sepsis calculator can reduce antibiotic exposure in neonates.. What is New: • EOS calculator can be an effective antibiotic stewardship tool in a high prescribing country and can reduce invasive diagnostic procedures and mother-baby separation. • Incidence of EOS in Greece is higher compared to other European countries.

EVALUATION OF CORD BLOOD CULTURE AS AN EARLY PREDICTOR FOR THE DETECTION OF EARLY ONSET NEONATAL SEPSIS IN TERTIARY CENTRE OF CENTRAL INDIA.

BACKGROUND : Neonatal sepsis is one of the major causes of neonatal morbidity and mortality. Peripheral venous blood culture and sensitivity is gold standard for the diagnosis of neonatal sepsis. Low sensitivity of blood culture in newborn is due to small volume of blood sample collected from neonates &amp; antibiotics given before sampling. AIM : To evaluate the utility &amp; compare the Umblical cord blood culture(UCBC) with Peripheral venous blood culture(PVBC) for detection of Early Onset Neonatal Sepsis(EONS) METHOD : 100 inborn neonates with two or more risk factors for EONS, chosen by sequential sampling method were included in this prospective analytical study. Blood samples were collected from umbilical cord and peripheral vein for culture. Sepsis screen was done to corroborate the diagnosis of neonatal sepsis. RESULT : Out of 100 neonates, 21 belongs to sepsis; 14 to probable sepsis; 65 to no sepsis. UCBC had Sensitivity-65.71% , Specicity-93.84%, PPV-85.18% , NPV-83.56% &amp; PVBC had Sensitivity-60% , Specicity-95.38% , PPV-87.5% , NPV-81.57%. CONCLUSION : UCBC is simple and convenient method for the diagnosis of EONS compared to PVBC. Organisms grown are comparable to PVBC sample.

Nurses Competences Regarding Nursing Care of Neonatal Sepsis 2019

Background: Neonatal sepsis is a serious problem causing high mortality in neonates. Neonatal sepsis has 2 type’s early onset neonatal sepsis which develop before 72 hours, and late onset neonatal sepsis which develop after 72 hours of birth. Methodology: This study aimed at assessing pediatric nurses' knowledge about neonatal sepsis. The sample size: was the total coverage consists of 30 nurses" which is the available number of pediatric nurses at the hospital during the study. The data collected: by using questionnaire and check list designed for the purpose of the study, and the data analyzed by using "SPSS". The result showed: (86.7%) of nurses knew the main cause of sepsis and mode of transmission of neonatal sepsis. Only (.16.7%) knew the prevention of neonatal sepsis, the nurses showed excellent performance (100%) advices mothers for cleaning. The study concluded the nurses have good knowledge and an excellent performance.

Alpha 1 Acid Glycoprotein as a Marker for Diagnosis of Early-Onset Neonatal Sepsis in Full-term Neonates

Alpha 1 Acid Glycoprotein as a Marker for Diagnosis of Early-Onset Neonatal Sepsis in Full-term Neonates

Clinical Early-Onset Sepsis Is Equally Valid to Culture-Proven Sepsis in Predicting Outcome in Infants after Preterm Rupture of Membranes.

Background: Culture-proven sepsis is the gold standard in early-onset neonatal sepsis diagnosis. Infants born ≤29 weeks gestation after preterm rupture of membranes in the years 2009–2015 were included in a retrospective cohort study performed at a level III fetal-maternal unit. The study aimed to compare culture-proven sepsis, clinical sepsis and positive laboratory biomarkers ≤72 h as predictors of mortality before discharge and the combined outcome of mortality or severe short-term morbidity (severe cerebral morbidity, bronchopulmonary dysplasia and retinopathy). Results: Of the 354 patients included, culture-proven sepsis, clinical sepsis and laboratory biomarkers were positive in 2.3%, 8.5% and 9.6%, respectively. The mortality rate was 37.5% for patients with culture-proven sepsis (3/8), 33.3% for patients with clinical sepsis (10/30) and 8.8% for patients with positive laboratory biomarkers (3/34), respectively. Mortality or severe morbidity occurred in 75.0% of patients with culture-proven sepsis (6/8), 80.0% of patients with clinical sepsis (24/30) and 44.1% of patients with positive laboratory biomarkers (15/34), respectively. Conclusion: In preterm infants after preterm rupture of membranes, clinical sepsis was almost four times more common and at least equally valuable in predicting mortality and mortality or severe morbidity compared to culture-proven sepsis.

Reducing Blood Culture and Antibiotic Usage in Neonates: Using Quality Improvement Science to Guide Implementation of a Neonatal Early-Onset Sepsis Calculator.

A maternal diagnosis of chorioamnionitis, based on maternal peripartum fever of 100.4°F alone, is commonly used as an indication for blood work and antibiotic treatment in newborns. New strategies such as the Kaiser Permanente early-onset sepsis (EOS) calculator have proven effective in identifying high-risk newborns and reducing unnecessary antibiotic administration. Retrospective data from October 2017 to September 2018 from 297 well-appearing newborns ≥35 weeks' gestational age (GA) with maternal chorioamnionitis showed that 93.6% had blood work and 90.2% were treated with antibiotics. This was despite no culture-positive cases of sepsis. Our aim was to reduce by 50% blood work evaluation and antibiotic treatment within a 6-month period. Using plan-do-study-act (PDSA) cycles, we adopted the Kaiser Permanente EOS calculator. We collected longitudinal data to track the outcomes after its implementation. In 423 newborns with maternal chorioamnionitis triaged with the EOS calculator from October 2018 to July 2020, the rates of blood culture and antibiotic treatment decreased from 93.6% to 26.7% and 90.2% to 12.3% (P < .0001). In the larger population of 6426 newborns ≥35 weeks' GA, the rate of blood culture and antibiotic treatment decreased from 12.8% to 5.8% and 9.9% to 2.5% (P < .0001). The EOS calculator substantially and safely decreases blood work and antibiotic administration in asymptomatic newborns with maternal chorioamnionitis. Our findings provide further evidence for the effectiveness and safety of the EOS calculator.Video abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Implementation of an adapted Sepsis Risk Calculator algorithm to reduce antibiotic usage in the management of early onset neonatal sepsis: a multicentre initiative in Wales, UK

ObjectiveAssess the impact of introducing a consensus guideline incorporating an adapted Sepsis Risk Calculator (SRC) algorithm, in the management of early onset neonatal sepsis (EONS), on antibiotic usage and patient...