How is neonatal sepsis treated?

Updated: Jun 13, 2019
  • Author: Nathan S Gollehon, MD, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Historically, the treatment approach for suspected neonatal sepsis has included early aggressive initiation of antibiotics because of the neonate’s relative immunosuppression. Because early signs of sepsis in the newborn are nonspecific, diagnostic studies are often ordered and treatment initiated in neonates before the presence of sepsis has been proven. Moreover, because the American Academy of Pediatrics (AAP), [22, 23] the American College of Obstetricians and Gynecologists (ACOG), [24] and the Centers for Disease Control and Prevention (CDC) [25] all have recommended sepsis screening or treatment for various risk factors related to group B Streptococcus (GBS) infections, many asymptomatic neonates now undergo evaluation and are exposed to antibiotics.

This approach has been questioned in recent years as more evidence emerges on the deleterious impact of unnecessary antibiotic exposure, including interference with the establishment of breast feeding, alternations in gut microbiome, increased incidence of childhood obesity and development of antimicrobial resistance amongst others. [26]  Furthermore, amongst very low birth weight infants who were initially treated with antibiotics but subsequently proved to have negative cultures, there was an increased risk of mortality and stage 3 retinopathy of prematurity. [55]

A newer approach to this issue has used a multivariate predictive model which considers maternal GBS status, appropriateness of intrapartum GBS coverage, gestational age, duration of rupture of membranes, highest intrapartum maternal temperature, along with the neonate’s postpartum examination findings. This model, commonly referred to as the “Kaiser Sepsis Calculator” has allowed for a significant reduction in the use of empiric antibiotics (from 5.0% of all births before implementation to 2.8% of all births thereafter) and obtaining blood cultures (12.8% of all births before implementation to < 5% of all births thereafter), without an increase in the rate of morbidity or mortality or readmissions for early-onset sepsis. [34, 35]

Use of this approach should be limited to term and late preterm infants of 34 weeks’ gestation or later. Use of the sepsis calculator should be implemented at an institutional level, taking into account local resources and the incidence of early-onset sepsis. A standardized approach will lead to improved risk identification as well as needed buy-in from important stakeholders, such as obstetricians, nursing staff, and other care team members.


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