- The American Academy of Pediatrics (AAP) has released new guidelines for early-onset sepsis (EOS) in neonates born >35 0/7 weeks' gestation, highlighting epidemiological distinctions and risk stratification strategies to guide diagnosis.
- Consult companion publication for 34 6/7 weeks' gestation guidance.
Why this matters
- Stratify infants by EOS risk level.
- Definition: pathogenic bacteria in blood or cerebrospinal fluid (CSF) culture obtained 72 hours postbirth.
- EOS incidence higher in late preterm vs term infants (1/1000 vs 0.5/1000 live births).
- Select risk stratification by ability to identify low-frequency adverse events, minimize antibiotic use:
- Categorical risk assessment based on intrapartum risk threshold values.
- Multivariate risk assessment that individualizes and synthesizes established risk factors, newborn clinical condition (e.g., Neonatal Early-Onset Risk Calculator).
- Serial physical examination relying on clinical signs of illness; approach uses categorical or multivariate approaches to risk accompanied by lab testing, and serial monitoring.
- Diagnosis: blood culture, ideally with CSF culture for infants at highest EOS risk. Do not perform if infant clinical condition would be compromised or antibiotics delayed.
- Treatment: ampicillin or gentamicin; add broad-spectrum agents in critically ill infants pending culture results.
- Discontinue empirical antibiotics by 36-48 hours if initial blood culture is negative, unless there is evidence of site-specific infection.