Risk Of Early-onset Neonatal Sepsis Research Articles

Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study

BackgroundSepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country.MethodsThis case–control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture.ResultsForty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml).ConclusionIn the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).

Empiric Antibiotic Use and the Outcome in Infants at Risk of Early Onset Neonatal Sepsis in a Teaching Hospital in South India: A Retrospective Cohort Study

Background Neonatal sepsis continues to be an important cause of mortality and morbidity in low- and middle-income countries. The identification and early treatment of infants at risk of early-onset neonatal sepsis (EONS) with empiric antibiotics is a preventive strategy. Objectives To study the use of empiric antibiotics in infants at risk for EONS and assess their outcome in terms of the development of sepsis, mortality, and duration of hospital stay. Materials and Methods This retrospective cohort study was done at the Special Newborn Care Unit, GMC Thrissur. The data of babies at risk of EONS over a period of 3 years (2020–2022) was collected. One thousand two hundred and thirty-two babies with at least one risk factor for sepsis, as defined by the National Neonatology Forum (NNF) 2021 guidelines, were enrolled in the study. The antibiotic prescription pattern and the outcomes were measured. Results Empirical antibiotic treatment was received by 61.2% (754/1232) of infants, and of those, 39.5% (298/754) developed EONS. Infants treated with Piperacillin/Tazobactam and Amikacin had a higher incidence of sepsis and mortality than those started on Ampicillin and Gentamicin ( p &lt; .001). In infants less than 32 weeks, the incidence of sepsis increased significantly with increase in number of risk factors ( p &lt; .001). Infants with lower birth weight and gestational age were more susceptible to developing sepsis ( p &lt; .001). EONS was significantly associated with neonatal resuscitation, umbilical vein catheterization, and invasive ventilation ( p &lt; .001). Infants who received empirical antibiotics had a longer hospital stay, with a mean duration of 4.38 days more compared to the no antibiotics group. Conclusion In infants at risk of EONS, the empirical use of antibiotics alone did not show a favorable effect on the incidence of EONS or sepsis-related mortality.

Evaluation of presepsin as a diagnostic tool in newborns with risk of early-onset neonatal sepsis.

To evaluate the efficacy of presepsin (P-SEP) as a potential biomarker of early-onset neonatal sepsis (EOS) and compare it to other routinely used markers of inflammation. To establish the cut-off values of P-SEP for EOS. 184 newborns were prospectively recruited between January 2018 to December 2020. Newborns >34th gestational week with suspected infection were included up to 72 h after delivery, and divided into three categories (i.e., unlikely, possible, and probable infection) based on risk factors, clinical symptoms and laboratory results. Values of plasma P-SEP were sequentially analyzed. Median values of P-SEP in newborns with probable infection were significantly higher compared to healthy newborns (p = 0.0000013) and unlikely infection group (p = 0.0000025). The AUC for discriminating the probable infection group from the unlikely infection group was 0.845 (95% Cl: 0.708-0.921). The diagnostic efficacy of P-SEP was highest when used in combination with IL-6 and CRP (0.97; 95% CI: 0.911-0.990). The optimal cut-off value of P-SEP was determined to be 695 ng/L. P-SEP, when combined with IL-6 and CRP, may be utilized as a negative predictive marker of EOS (NPV 97.2%, 95% CI: 93.3-101), especially in newborns at low to medium risk of infection.

The full blood count in screening asymptomatic infants for early-onset sepsis: A cross-sectional study.

The full blood count (FBC) is commonly measured as part of a partial septic work-up in asymptomatic infants at increased risk of early-onset neonatal sepsis (EOS). To determine the impact of FBC parameters on infants' subsequent management a retrospective cross-sectional study was performed. Infants, born at ≥34 weeks gestation, asymptomatic at birth, undergoing a partial septic work-up and receiving prophylactic antibiotics due to increased risk of EOS in a single centre over a 2-year period, were included. The primary outcome measure was frequency of FBC result impacting on duration of antibiotic therapy. Secondary outcome measures included frequency of FBC parameters outside of the reference range and incidental diagnoses. In total, 16 726 live-born infants were delivered during the study period. A total of 802 (4.8%) were included. Thirteen infants (1.6%) received a prolonged course of antibiotics due to suspicion for EOS. Two of these infants had elevated white cell counts. All had normal neutrophil counts. In no case did the FBC result influence the decision to prolong the antibiotic course. In a cohort of 802 infants, asymptomatic at birth and at increased risk of EOS, the FBC result did not impact on the decision to prolong the course of antibiotics for suspicion of EOS.

Umbilical cord blood interleukin-6 level as a predictor of early-onset neonatal sepsis

&#x0D; &#x0D; Background Neonatal sepsis is a global health problem contributing significantly to neonatal morbidity and mortality. It is difficult to clinically distinguish neonates with and without sepsis. Interleukin-6 (IL-6) concentration in neonates has high sensitivity and specificity to predict neonatal sepsis in infants at risk.&#x0D; Objective To determine the utility of umbilical cord blood IL-6 as a predictor of early-onset neonatal sepsis.&#x0D; Methods This prospective cohort study was conducted in neonates born to mothers with sepsis risk factors from December 2020 to January 2021. We measured IL-6 from umbilical cord blood taken after placental expulsion. IL-6 ³16.4 pg/ml was considered to be elevated. Subjects were monitored for signs of clinical sepsis until 72 hours after birth. We also recorded the presence of other maternal and infant risk factors of sepsis and assessed association between IL-6 and other risk factors with the occurrence of sepsis, expressed as relative risk (RR) with 95% confidence interval (95%CI).&#x0D; Results During the study period, 40 neonates were born to mothers with sepsis risk factors; 13 (32.5%) developed clinical sepsis. Significantly more infants with elevated IL-6 developed neonatal sepsis (55.5%) than those with normal IL-6 (13.6%). After multivariate analysis incorporating other significant variables, the risk factors predictive of clinical early-onset neonatal sepsis were IL-6 [RR 5.54 (95%CI 1.68-18.25); P=0.016], prematurity [RR 4.92 (95%CI 1.66-14.59); P=0.014], and initial Apgar score [RR 3.38 (95%CI 1.34-3.38); P=0.046].&#x0D; Conclusion In neonates with maternal risk factors, an IL-6 level of ³16.4 pg/ml is associated with an increased risk of early-onset neonatal sepsis.

Conservative management of newborns with 35 weeks or more of gestational age at risk for early-onset sepsis: a Brazilian cohort study

ObjectiveTo evaluate the conservative management of newborns born at ≥35 weeks of gestational age, at risk for early-onset neonatal sepsis (EOS). MethodsRetrospective, analytic cohort study (2016 to 2019), including newborns ≥35 weeks of gestational at risk of EOS, asymptomatic at birth, managed conservatively in full rooming-in: serial physical examination and clinical observation for at least 48 h. They were classified into three groups, according to the clinical course: asymptomatic (group A), symptomatic for other reasons (group B), and with sepsis (group C). Risk factors, clinical signs and differential diagnoses of sepsis, length of stay, and discharge conditions were evaluated. ResultsThe authors evaluated 769 asymptomatic newborns at risk of EOS. (mean birth weight 2999 ± 485 g and gestational age 37.6 ± 1.7 weeks, respectively) corresponding to 12.2% of rooming-in admissions. The most prevalent risk factors were colonization by Group B Streptococcus (29%), prolonged rupture membrane duration (21.9%) and preterm labor (21.4%). Most of all of them (53.9%) remained asymptomatic (group A). Group B corresponded for 45.3%, and the most common clinical signs were hypothermia (24.5%), tremors (8.7%) and vomiting (8%). Environmental dysthermia (50.7%), prematurity (20.0%), and feeding intolerance (15.7%) were common in Group B. Laboratory tests were performed in 3.5%. Five patients (one confirmed) comprised group C (0.8/1,000 live births). There were no deaths. The median length of stay was 64 h (IQR 50-93). ConclusionThe rate of clinical/confirmed EOS was low. Most of the symptomatic patients only needed clinical evaluation to rule out sepsis. Management was shown to be safe.

Delivery Characteristics and the Risk of Early-Onset Neonatal Sepsis.

Multiple strategies are used to identify newborn infants at high risk of culture-confirmed early-onset sepsis (EOS). Delivery characteristics have been used to identify preterm infants at lowest risk of infection to guide initiation of empirical antibiotics. Our objectives were to identify term and preterm infants at lowest risk of EOS using delivery characteristics and to determine antibiotic use among them. This was a retrospective cohort study of term and preterm infants born January 1, 2009 to December 31, 2014, with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Criteria for determining low EOS risk included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. We determined the association between these characteristics, incidence of EOS, and antibiotic duration among infants without EOS. Among 53 575 births, 7549 infants (14.1%) were evaluated and 41 (0.5%) of those evaluated had EOS. Low-risk delivery characteristics were present for 1121 (14.8%) evaluated infants, and none had EOS. Whereas antibiotics were initiated in a lower proportion of these infants (80.4% vs 91.0%, P < .001), duration of antibiotics administered to infants born with and without low-risk characteristics was not different (adjusted difference 0.6 hours, 95% CI [-3.8, 5.1]). Risk of EOS among infants with low-risk delivery characteristics is extremely low. Despite this, a substantial proportion of these infants are administered antibiotics. Delivery characteristics should inform empirical antibiotic management decisions among infants born at all gestational ages.

Vitamin D Levels and Early Onset Sepsis in Newborns

Aim: To find out association between vitamin D level and early onset neonatal sepsis (EONS). Methods: This case control study was conducted at a tertiary care center in Northern India during June 2018 to May 2019. Neonates with culture-proven EONS were included as case and neonates without EONS were enrolled as control. 25OH-D levels were evaluated with other routine blood samples. Statistical analysis was done by using unpaired t test and chi-square test. Results: Sixty-two infants were enrolled in each group; baseline characteristics were comparable in both groups. Risk of EONS increased 8 times in neonates with 25OH-D level &lt;30 ng/mL (odds ratio = 8.2; 95% confidence interval [CI]: 3.08-21.82; P = .000). The 25OH-D level was significantly lower in EONS group than control group. Optimal cut-off for 25OH-D was 25 ng/mL to predict EONS with a sensitivity and specificity of 88.7% and 79%, respectively (area under the curve: 0.84; 95% CI: 0.76-0.92; P = .000). Conclusions: Vitamin D insufficiency is significantly associated with EONS. Vitamin D deficiency significantly increases risk of EONS. Maternal vitamin D supplementation may improve neonatal vitamin D levels and may decreases risk of EONS. Further studies including maternal vitamin D level are required for implementation.

Term newborns at risk for early-onset neonatal sepsis: Clinical surveillance versus systematic paraclinical test

IntroductionEarly-onset neonatal sepsis is a rare but potentially lethal infection that is very often suspected in daily practice. Previous national guidelines recommended the use of systematic paraclinical tests for healthy term newborns with suspected infection. These guidelines were updated in 2017 by the French Health Authority (Haute Autorité de santé), and promote initial clinical monitoring taking into account the infectious risk level for term and near-term born infants. ObjectivesTo assess the impact of the new recommendations on antibiotic therapy prescription and invasive tests, and on the outcomes of infants born from 36weeks’ gestation. Materials and methodsThis study compared the management and the outcome of neonates born from 36weeks’ gestation at the level III University Hospital of Nancy, according to their infectious risk level during two periods, before and after the update of national recommendations: from July 1 to December 31, 2017, versus July 1 to December 31, 2018. Data were retrospectively collected from the infants’ files. This study compared the number and length of antibiotic treatment and the number of invasive tests, the number of documented infections, the number and length of hospitalization, and mortality between the two periods. ResultsDuring the first period, among 1248 eligible newborns, 643 presented an infectious risk factor, versus 1152 newborns with 343 having an infectious risk factor during the second period. Antibiotic treatment was initiated for 18 newborns during the first period (1.4%) and for nine during the second (0.8%) (P=0.13). The mean (SD) duration of the antibiotic treatment was longer in the first than in the second period: 6.3±2days vs. 3.1±2.3days (P=0.003). There was no death related to neonatal infection. A total of 1052 blood samples were collected during the first period versus 51 during the second (P<0.01). There was no documented infection. In the first period, there were 18 newborns (1.4%) hospitalized for suspected infection versus nine (0.8%) in the second period (P=0.13). The duration of hospitalization was 5.7±1.7days in the first period versus 5.2±3days in the second (P=0.33). ConclusionIn this study, the application of the new guidelines enabled a reduction of antibiotic exposure and a reduction of invasive tests without additional risk.

Association of Intrapartum Risk Factors and Infant Clinical Indicators with Culture Confirmed Early Onset Neonatal Sepsis in a Secondary Care Rural Hospital in India.

The aim of this study is to determine the association of intrapartum risk factors and infant clinical indicators using the National Institute for Health and Care Excellence (NICE) criteria with culture-positive early-onset neonatal sepsis (EONS) from a rural secondary healthcare facility where intrapartum prophylactic antibiotics are routinely administered to high-risk mothers. A single-center prospective observational study was conducted between July 2017 and September 2018. All intramural neonates with at least one NICE criteria at less than 72 h of life, were included. Univariate logistic regression and multivariable logistic backward elimination analyses were conducted to investigate individual risk factors and predictive models for culture proven EONS. Of 236 newborns who were at risk for EONS by NICE criteria, 32 (13.8%) had positive blood cultures. Klebsiella species (n = 13, 39.4%) and Acinetobacter species (n = 11, 33.3%) were the most common isolated bacteria. In univariate analysis, the number of infant clinical indicators were associated with culture positive EONS (OR 1.36; 95% CI 1.01-1.81), but not the number of intrapartum risk factors (OR 0.76; 95% CI 0.4-1.29). The multivariate logistic regression with backward elimination procedure suggested that a model including absolute neutrophil count [adjusted OR (aOR) 0.81; 95% CI 0.72-0.92], C-reactive protein (aOR 1.24; 95% CI 1.08-1.43) and the number of clinical indicators (aOR 1.29; 95% CI 0.93-1.80) could be useful to predict culture positive EONS in our setting. In this maternal and neonatal cohort, infant clinical indicators rather than intrapartum risk factors were associated with culture confirmed EONS.

A sepsis risk calculator can decrease antibiotic exposure in neonatal early-onset sepsis screening.

Early-onset neonatal sepsis (EONS) can have devastating consequences. Historically, clinicians treated at-risk patients with antibiotics while awaiting blood culture results. This strategy, however, resulted in substantial antibiotic overtreatment over the last three decades.1 Consequences of early antibiotic overexposure include microbiome alterations2, 3 which are linked to development of asthma, food allergies and childhood obesity.4-7 Intrapartum antibiotic strategies have reduced the incidence of EONS since the 1990s, and clinicians now must weigh the risk of EONS with the risk of negative impacts from antibiotic overtreatment. Methods to prevent overtreatment include algorithm-based risk factor assessments to distinguish infants truly at risk for EONS. A newer tool, the SRC, is a multivariate risk assessment method that synthesises risk factors and the newborn clinical condition to provide a probability of EONS for each infant.8, 9 The authors of this study estimated that, had the SRC been applied to their cohort of 3593 infants managed with NICE guidelines over a three-month period, antibiotic therapy could have been avoided in nearly three-quarters of treated infants. However, applying a hypothetical management approach retrospectively to a cohort managed with another approach prospectively obviously does not provide the same level of evidence as head to head randomised trials. Studies such as this should be interpreted with caution. In this study, assessors of the SRC-based approach were aware of the NICE guideline-based assessment of risk, the actual use of antibiotics in study infants and the eventual clinical outcomes. Non-blinding may have led to bias in estimating the potential effects of the SRC recommendations. Additionally, the true incidence of EONS in this cohort of patients was at least 1.2/1000 live births (6 infants out of 4992), but the authors used an estimated incidence of 0.5/1000 for the SRC. Using the known EONS incidence of this cohort of patients in the SRC may have resulted in a significant change in antibiotic usage. Readers should note that several infants with EONS were deemed to be at low/no risk using either approach, but subsequently developed clinical signs of sepsis. These infants were identified by clinical vigilance, which may be the ultimate safety net for EONS detection and treatment. The authors do recommend close observation of newborns identified as high risk by NICE but not recommended antibiotics by SRC, and discharge after 12-24 hours of monitoring. One reasonable conclusion from this study is that a combination of using the SRC along with clinical vigilance offers the best approach, where antibiotic overuse is avoided, and infants who clinically deteriorate are detected and treated early. Even with promising results such as in this study, clinicians should cautiously develop local practice guidelines based on a comprehensive review of the evidence, local contextual and practice conditions (eg the feasibility of frequent clinical monitoring of infants at risk), the baseline rate of EONS and parental preferences and values. The guidelines should be accompanied by rigorous monitoring for unexpected consequences to ultimately ensure that the goal of achieving a balance between treating EONS early while avoiding needless antibiotics is met. https://ebneo.org/2016/11/admission-hypoand-hyperthermia-are-associated-with-increa None.

Early-Onset Neonatal Sepsis

Abstract Despite the great progress made in neonatal and perinatal medicine over the last couple of decades, sepsis remains one of the main causes of morbidity and mortality. Sepsis in pediatric population was defined at the Pediatric Sepsis Consensus Conference in 2005. There is still no consensus on the definition of neonatal sepsis. Neonatal sepsis is a sepsis that occurs in the neonatal period. According to the time of occurrence, neonatal sepsis can be of early onset, when it occurs within the first 72 hours of birth and results from vertical transmission, and of late onset, in which the source of infection is found most often in the environment and occurs after the third day of life. The most common causes of early-onset sepsis are Group B Streptococcus (GBS) and E. coli. Risk factors can be mother-related and newborn-related. Clinical symptoms and signs of sepsis are quite unspecific. The dysfunction of different organs may imitate sepsis. On the other hand, infectious and non-infectious factors may exist simultaneously. The start of the antimicrobial therapy in any newborn with suspected sepsis should not be delayed. Pentoxifylline may have potential benefits in preterm newborns with sepsis. The only proven intervention that has been shown to reduce the risk of early-onset neonatal sepsis is intrapartum intravenous antibiotic administration to prevent GBS infection. It is still a great challenge to discontinue antibiotic treatment in non-infected newborns as soon as possible, because any extended antibiotic use may later be associated with other pathological conditions.

Leukocyte Counts and Other Hematological Values in Twin-Twin Transfusion Syndrome and Twin Anemia-Polycythemia Sequence

Objective: The aim of this study was to evaluate the differences in leukocyte counts at birth between donors and recipients with twin-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS). Methods: We performed a retrospective cohort study in monochorionic twin pairs with TTTS or TAPS. TTTS and TAPS cases treated with fetoscopic laser surgery were excluded. Primary outcome was the difference in leukocyte levels at birth between donor and recipient twins and the presence of leukopenia (defined as leukocyte count <4 × 10⁹/L). Secondary outcomes included early-onset sepsis, necrotizing enterocolitis, use of antibiotics during admission, and neonatal mortality. Results: We included 99 twins pairs, of which 61 twin pairs were affected by TAPS and 38 twin pairs by TTTS. The mean leukocyte count at birth in donors and recipients was 7.5 × 10⁹/L versus 7.4 × 10⁹/L (p = 0.936), respectively. Leukopenia was significantly more common in donor twins compared to recipient twins (7.1% [7/99] vs. 0% [0/99], p = 0.016). Of the 7 donors with leukopenia, 6 were affected by TAPS and 1 by TTTS. Overall, donors were more often affected by early-onset sepsis than recipients, 23.7% (23/97) versus 13% (13.7/95) (p = 0.049), respectively. Conclusions: Leukocyte counts at birth in twins with TTTS or TAPS are similar between donors and recipients, but TAPS donors are at an increased risk of leukopenia. Overall, TTTS and TAPS donors seem to be at an increased risk of early-onset neonatal sepsis compared to recipient twins.

Incidence of Fever in Labor and Risk of Neonatal Sepsis

(Am J Obstet Gynecol. 2017;216(6):596.e1–596.e5) Maternal fever alone during labor may be a sign of chorioamnionitis and an indication for antibiotic therapy. However, there are no published obstetrical guidelines devoted to the management of chorioamnionitis. Reports of physician diagnosed chorioamnionitis may underestimate rates (3.1% whereas a few large studies suggest it to be closer to 7%), and clinical management varies across institutions. Therefore, in the present study, authors evaluated the rate of fever during labor and assessed risk for early-onset neonatal sepsis in newborns delivered from mothers with intrapartum fever compared with those delivered from mothers without fever.

Limiting the Exposure of Select Fetuses to Intrauterine Infection/Inflammation Improves Short-Term Neonatal Outcomes in Preterm Premature Rupture of Membranes

Background: To improve neonatal outcomes in pregnancies at heightened risk for early-onset neonatal sepsis (EONS), there is a need to identify fetuses that benefit from expectant management as opposed to early delivery. Detectable haptoglobin and haptoglobin-related protein (Hp&HpRP switch-on status) in cord blood has been proposed as a biomarker of antenatal exposure to intra-amniotic infection and/or inflammation (IAI), an important determinant of EONS. Subjects and Methods: We analyzed 185 singleton newborns delivered secondary to preterm premature rupture of membranes (PPROM). In 123 cases, amniocentesis was performed to exclude amniotic fluid (AF) infection. Delivery was indicated for 61 cases with confirmed infection. Women without AF infection (n = 62) and those without amniocentesis (n = 62) were managed expectantly. Interleukin 6 and Hp&HpRP switch-on status were evaluated by ELISA and Western blot. Newborns were followed prospectively for short-term outcomes until hospital discharge or death. Results: Newborns exposed antenatally to IAI had an increased risk of adverse neonatal outcome [OR: 3.0 (95% CI: 1.15-7.59)]. Increasing gestational age [OR: 0.61 (95% CI: 0.52-0.70)] and management with amniocentesis [OR: 0.37 (95% CI: 0.14-0.95)] lowered the newborn's risk of developing adverse outcomes. Discussion: In the setting of PPROM and IAI, early delivery benefits a select subgroup of fetuses that have not yet progressed to Hp&HpRP switch-on status.

The risk of early-onset neonatal sepsis in preterm infants with maternal histologic chorioamnionitis

Background Chorioamnionitis, usually a subclinical condition, maycause preterm delivery and long-term morbidity.Objective The objective of this study was to determine the risk ofearly-onset neonatal sepsis in preterm infants with maternal histo-logic chorioamnionitis (HCA).Methods This was a prospective cohort study of preterm infantsborn at Sanglah Hospital, Denpasar from September 2002 to Feb-ruary 2004. Histopathological examinations of the subjects’ placen-tas were done and the infants were monitored for 72 hours for clini-cal signs of early-onset neonatal sepsis. Maternal and neonatal riskfactors were analyzed using multivariate statistical analysis.Results Eighty-two preterm infants were included, of which 41 werepositive for maternal HCA. Twenty-five (61%) of the infants posi-tive for maternal HCA developed early-onset neonatal sepsis, com-pared to 5 (12%) of those negative for maternal HCA (RR=5, 95%CI2.12;11.78). Nine infants died from early onset neonatal sepsis.Eight of them had positive HCA, and only one had negative HCA.The average length of hospital stay between infants with and with-out maternal HCA did not differ significantly [12.0 (SD 5.08) vs.12.6 (SD 1.34); P=0.80]. Logistic regression model analysis iden-tified only HCA as a significant risk factor for early-onset neonatalsepsis (OR=6.9, 95%CI 2.0;23). Gestational age (OR=1.3, 95%CI0.8;2.0), birth weight (OR=1.0, 95%CI 0.9;1.0), and neonatal as-phyxia (OR=1.0, 95%CI 0.1;4.4) were not found to be significantrisk factors.Conclusion Preterm infants with maternal histologicchorioamnionitis are at a higher risk for developing early-onsetneonatal sepsis

The relation between vitamin D level and increased risk for early-onset neonatal sepsis in full-term infants

Objectives The aim of the study was to determine the role of maternal and neonatal plasma vitamin D levels in early-onset sepsis (EOS) and in its severity in term infants. Methods This study was performed on 60 neonates and their mothers who were divided into two groups. Group 1 comprised 30 full-term neonates with EOS. Group 2 comprised 30 healthy neonates of matched age and sex who served as the control group. All participants were subjected to the following investigations: complete blood count, C-reactive protein, blood culture and serum vitamin D levels in both neonates and their mothers. Results Maternal and neonatal vitamin D levels were lower in the study group compared with the control group and their levels were significantly higher in the summer season. We found a significant negative correlation between infant vitamin D level and C-reactive protein in the patient group. In contrast, there was a significant positive correlation between maternal and neonatal vitamin D levels in both groups. The best cutoff value of neonatal vitamin D for the risk of sepsis was 14.4 ng. Conclusion Lower maternal and neonatal vitamin D levels are associated with EOS. However, there was no significant relation between vitamin D deficiency and outcome.

Increased Risk Of Early-Onset Neonatal Sepsis After Laser Surgery For Twin-to-Twin Transfusion Syndrome.

To investigate the occurrence of early-onset neonatal sepsis (EOS) in twin-twin transfusion syndrome (TTTS) managed with laser surgery. We performed a prospective cohort study of all consecutive TTTS cases treated with laser surgery (TTTS group) delivered at the Leiden University Medical Center. We recorded the occurrence of EOS, defined as a positive blood culture ≤72 hours postpartum (proven sepsis) or administration of a full course of antibiotics due to risk factors or signs of sepsis, in the absence of a positive blood culture (suspected sepsis). Perinatal variables in the TTTS group were compared with uncomplicated monochorionic twins (no-TTTS group). A multivariate model was generated, examining the association between EOS and gestational age at birth, interval between laser surgery and birth, anterior placenta, laser period (first study period: 2002-2008; second study period: 2009-2015), and preterm premature rupture of membranes (PPROM). The rates of combined suspected and proven EOS in the TTTS group and no-TTTS group were 16% (68/416) and 10% (55/542), respectively (relative ratio [RR] 1.74, 95% confidence interval [CI] 1.19-2.55). Multivariate analysis showed that EOS in the TTTS group was independently associated with lower gestational age at birth (odds ratio [OR] 0.75, 95% CI 0.63-0.88), first study period (OR 2.25, 95% CI 1.08-4.67) and PPROM (OR 2.47, 95% CI 1.28-4.75). The rate of EOS in the TTTS group is low, but increased compared to the no-TTTS group. EOS in TTTS is independently associated with premature delivery, earlier laser period, and PPROM.

Current Evidence on Prevention and Management of Early Onset Neonatal Sepsis

Early onset neonatal sepsis (EONS) continues to be a challenge in modern neonatal care and is fraught with many diagnostic and management conundrums. In a large single centre report the incidence of sepsis in intramural babies was 0.7% and the reported mortality due to sepsis/meningitis was 4.1% [1]. Institutional protocols vary in the various aspects of antenatal and postnatal care. Identifying neonates at risk for EONS by maternal risk factor assessment or maternal screening, intrapartum antibiotic prophylaxis and other maternal interventions for reducing the incidence, ideal haematological parameters, acute phase reactants and sepsis screen for at risk neonates, improving the blood culture yield, lumbar puncture for cerebrospinal fluid (CSF) examination, selection of antibiotic, duration of therapy and role of intravenous immunoglobulin are some of the questions which plague the clinician.

Reappraisal of Guidelines for Management of Neonates with Suspected Early-Onset Sepsis

Since 1992, professional societies or public health agencies in the United States1–12 and elsewhere13–17 have issued several generations of recommendations for prevention or management of early-onset neonatal sepsis (EOS). Despite those efforts, recommendations remain inconsistent, clarifications are necessary18, local adaptations are common19, and compliance rates are low20. We postulate that lack of consensus, especially regarding postnatal management of the neonate, is largely a result of two sets of factors. First, obstetrical prevention strategies have substantially reduced incidence of EOS, potentially changing the utility of predictive strategies based on risk factors. Second, recent data better delineate relationships among risk factors, clinical signs, and EOS, suggesting that risk predictors may have different utilities in different groups. The purpose of this commentary is to explore these questions and to suggest new approaches to management of newborns who may be at risk for EOS.