AAP: new guidelines for early-onset sepsis in late preterm infants

  • Pediatrics

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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.

Key points

  • 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.

See also: AAP: new guidelines for early-onset sepsis in very early preterm infants

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