- The American Academy of Pediatrics (AAP) has released new guidelines that highlight birth circumstances in identifying high early-onset sepsis (EOS) risk in very early-term (34 6/7 weeks' gestation) neonates.
- Consult companion publication for >35 0/7 weeks' gestation neonates recommendations.
Why this matters
- Use preterm birth circumstances to inform EOS risk categorization and treatment.
- Adult sepsis biomarkers (C-reactive protein, procalcitonin) are insufficiently sensitive/specific for neonatal sepsis.
- Definition: pathogenic bacteria in blood or cerebrospinal fluid (CSF) culture obtained 72 hours postbirth.
- Risk categorization is driven by preterm birth circumstances:
- Cesarean delivery due to maternal illness, placental insufficiency: low EOS risk; consider risk/benefit of evaluation, empirical antibiotics for infants not improving/with systemic instability.
- Maternal cervical incompetence, preterm labor, preterm rupture of membrane, clinical intra-amniotic infection, unexplained/nonreassuring fetal status: highest EOS risk. Evaluate by blood culture, initiate empirical antibiotics.
- Diagnosis: blood culture is diagnostic standard; balance physiologic stability, EOS risk, harms of delayed antibiotics when using CSF cultures.
- Treatment: ampicillin or gentamicin; routine, empirical broad-spectrum agents may be harmful, except in severely ill infants at higher EOS risk (especially post-antepartum maternal antibiotic therapy), and while awaiting culture results.
- Discontinue empirical antibiotics by 36-48 hours if initial blood culture is negative, unless there is evidence of site-specific infection.