pediatrics
Neonatal Sepsis
Prevention of Neonatal Sepsis
Neonates who appear well may be at risk of group B streptococcus infection. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) currently recommend managing these infants depending on several factors ( Prevention references , Presence of chorioamnionitis Whether Maternal indications for group B streptococcus prophylaxis and given appropriately Gestational age and the duration of membrane rupture If there is neither chorioamnionitis nor indication for group B streptococcus prophylaxis, no testing or treatment is indicated. preterm and term neonates should have a blood culture at birth and begin Antimicrobials . Testing should also include white blood cell count and differential and C-reactive protein at 6 to 12 hours of life. Further management depends on the clinical course and results of the laboratory tests. Ifmaternal group B streptococcus prophylaxis was indicated and given appropriately(ie, penicillin,ampicillin, orcefazolingiven IV for ≥ 4 hours), infants should be observed in the hospital for 48 hours; testing and treatment are done only if symptoms develop. Selected patients ≥ 37 weeks gestation who have reliable caretakers and ready access to follow-up may go home after 24 hours. Ifadequate group B streptococcus prophylaxis was not given,infants are observed in the hospital for 48 hours without antimicrobial therapy. If membranes ruptured ≥ 18 hours before birth or gestational age is < 37 weeks, blood culture, CBC with differential, and perhaps a C-reactive protein level is recommended at birth and/or at 6 to 12 hours of life. The clinical course and results of the laboratory evaluation guide management. Alternative approaches to risk-stratifying neonates with respect to early-onset sepsis based on both maternal risk factors and the serial newborn examination are becoming more widely implemented but are not currently recommended by the CDC or AAP ( Prevention references ). Giving IV immune globulin to augment the neonate's immune response has not been shown to help prevent or treat sepsis. All pregnant women should be screened for GBS colonization late in gestation using both vaginal and rectal culture. Women with a positive GBS screenshould be given intrapartum antibiotic prophylaxis unless they are undergoing cesarean delivery before labor starts and before membrane rupture. Women with a negative GBS screenshould receive intrapartum antibiotics if they previously gave birth to an infant with GBS disease. Women whose GBS status is unknown(eg, because they were not tested or results are unavailable) should receive intrapartum antibiotics if ≥ 1 of the following factors are present: < 37 weeks gestation Rupture of membranes for ≥ 18 hours Temperature ≥ 38° C Possibly if there was a positive GBS screen during a previous pregnancy Women who had a positive GBS screen in one pregnancy have a 50% probability of having GBS colonization in a subsequent pregnancy ( Prevention references ). Antibiotics typically used include penicillin,ampicillin, orcefazolinand should be given IV for ≥ 4 hours before delivery. Selection should take into account local GBS antimicrobial resistance patterns. 1.Brady MT, Polin RA: Prevention and management of infants with suspected or proven neonatal sepsis.Pediatrics132:166-8, 2013. doi: 10.1542/peds.2013-1310 2.Polin RA and the Committee on Fetus and Newborn: Management of neonates with suspected or proven early-onset bacterial sepsis.Pediatrics129:1006-1015, 2012. doi: 10.1542/peds.2012-0541 3.Escobar GJ, Puopolo KM, Wi S, et al: Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation.Pediatrics133(1):30–36, 2014. doi: 10.1542/peds.2013-1689.Clarification and additional information.Pediatrics134(1):193, 2014. 4.Puopolo KM, Lynfield R, Cummings JJ, et al: Management of infants at risk for group B streptococcal disease.Pediatrics144(2):e20191881, 2019. doi: 10.1542/peds.2019-1881 