Early-onset neonatal sepsis: Finding a needle in a haystack

Sepsis is an uncommon disease, especially in infants ≥35 weeks' gestation when the incidence general population 0.5-1.0/1000 live births. Although higher symptomatic and those with risk factors, sepsis evaluations are far more common than proven sepsis. How can practitioners identify one baby from many factors or clinical signs (finding a needle haystack)? For decades, clinicians have relied on laboratory testing to decide which well appearing require antibiotics at birth. Unfortunately, screening tests poor predictive accuracy cannot pinpoint need empiric antibiotic therapy. The alternative treat every infant certain for such as chorioamnionitis, even if appears well. That was approach recommended by Committee Fetus Newborn 2010, led overtreatment of large uninfected babies. Treating also problematic because some solely physiological transition they undergo immediate postnatal period. Use “Sepsis Calculator” developed Puopolo Escobar dramatically reduced numbers undergoing workups, but still results 200 each treated case early-onset fails considerable portion infected infants. In this volume Journal Pediatrics, Achten et al completed individual patient data meta-analysis studies published between 2011 2020. Among 234 confirmed early onset cases, application “Calculator” resulted initial assignments strong consideration administration 40.6%, frequent vital 15.4%, routine care 44%. By 12 hours age, these proportions changed slightly 61.1%, 11.1%, 27.8% respectively. These support importance repeated physical examinations all suspected based signs. Unless “needle” becomes sharper newer, specific, validated methods, planned serial remain safest who appear birth earliest possible time. optimal assessments their frequency duration be determined, responsibilities performance assigned action plans delineated. threshold deciding should evaluation therapy begun guided calculator, ultimately will decided provider bedside. Article page 77 ▸ Stratification Culture-Proven Early-Onset Cases Neonatal Calculator: An Individual Patient Data Meta-AnalysisThe PediatricsVol. 234PreviewTo provide comprehensive assessment stratification (EOS) Calculator, novel tool reducing unnecessary treatment. Full-Text PDF Open Access