Mx of neonates born at ≤34 6/7 weeks’ gestation with suspect
The present article has been published recently in the journal Pediatrics. This clinical report provides guidance for the development of evidence-based approaches to sepsis risk assessment among preterm newborn infants.

Early-onset sepsis (EOS) remains a serious and often fatal illness among infants born preterm, particularly among newborn infants of the lowest gestational age. Currently, most preterm infants with very low birth weight are treated empirically with antibiotics for risk of EOS, often for prolonged periods, in the absence of a culture-confirmed infection.

Gestational age is the strongest single predictor of EOS, and the majority of preterm births occur in the setting of other factors associated with risk of EOS, making it difficult to apply risk stratification strategies to preterm infants. Laboratory tests alone have a poor predictive value in preterm EOS. Delivery characteristics of extremely preterm infants present an opportunity to identify those with a lower risk of EOS and may inform decisions to initiate or extend antibiotic therapies.

Some of the key points in the article are:-

• The diagnosis of EOS is made by a blood or CSF culture. EOS cannot be diagnosed by laboratory tests alone, such as CBC count or CRP levels.

• The combination of ampicillin and gentamicin is the most appropriate empirical antibiotic regimen for infants at risk for EOS. Empirical administration of additional broad-spectrum antibiotics may be indicated in preterm infants who are severely ill and at a high risk for EOS, particularly after prolonged antepartum maternal antibiotic treatment.

• When blood cultures are sterile, antibiotic therapy should be discontinued by 36 to 48 hours of incubation, unless there is clear evidence of site-specific infection.

• Persistent cardiorespiratory instability is common among preterm infants with VLBW and is not alone an indication for prolonged empirical antibiotic administration.

• Laboratory test abnormalities alone rarely justify prolonged empirical antibiotic administration, particularly among preterm infants at a lower risk for EOS.

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