CPG Neonatal Sepsis Flashcards
Is there use of an early onset neonatal sepsis calculator for neonates delivered to mothers with UTI within two weeks prior to delivery?
No recommendation
Among newborns with risk factors, should a single abnormal parameter in a CBC done within the 6th-24th hour of life used alone to diagnose sepsis?
Not used
A combination of CBC and any single quantitative CRP is not accurate in diagnosing sepsis in asymptomatic newborns but may be more useful in ruling out sepsis when done after 24 hours of life.
- CRP concentration is low at birth and may be normal during the initial stages of an infection
- CRP levels may rise at least 12 hours after onsetof infection and its sensitivity increases with serial determinations 24-48 hours after onset of symptoms
- CRP determination at birth or at initial presentation of infection is not recommended
- reliability increases in the 24-48 hours after birth or after the onset of infection
Septicemia is defined as?
having a positive blood culture for a bacterial pathogen
Early-onset sepsis is defined as
A positive blood or CSF culture in neonates whose specimen were obtained within 72 hours of delivery
Late-onset sepsis was defined as
infection occurring after the third day of delivery
Among newborns with EARLY-ONSET sepsis, a blood culture, when positive, is USEFUL to predict CNS infection and should warrant lumbar puncture.
A positive CSF and blood culture are strongly indicative of CNS infection
Among newborns with LATE-ONSET sepsis, blood culture result is NOT USEFUL in predicting CNS infection.
Therefore, lumbar puncture is still recommended.
Universal culture-based screening of women near term should not be performed to prevent early-onset GBS disease
Universal culture-based screening among women near term is NOT RECOMMENDED for preventing early-onset GBS sepsis
Among newborns with severe sepsis, double volume exchange transfusion as an adjunct treatment is recommended.
DVET as as add-on treatment is recommended in tertiary hospitals with adequate resources
The use of fresh frozen plasma among newborns with sclerema neonatorum in order to decrease morbidity and mortality is not recommended.
The signal of harm warranted a strong recommendation to not use FFP transfusion among newborns with sclerema neonatorum
Antibiotic prophylaxis for asymptomatic newborns delivered meconium stained is not recommended.
- rampant use of unnecessary antibiotics in neonates which may cause harm
- meconium passing in utero does not equate to the fetus having an infection therefore antibiotic therapy is NOT NECESSARY
- shorter hospital stay and lower cost
- promoting antibiotic stewardship
A 5-day course over a 7-day course of intravenous antibiotic is not recommended for newborns with clinical sepsis who improve after initial antibiotic therapy.
> UK: newborns with positive blood culture and strong suspicion of sepsis even after a negatibe blood culture - 7 days
WHO IMCI: IV antibiotics should be at least 7-10 days in infants <2 mos old with serious bacteria infection
US AAP: if blood culture is sterile - antibioticd should be STOPPED by 36-48 hrs of incubation unless there is proven infection
Among healthy-looking newborns presenting with fever alone, 20% of them will develop sepsis.
Likelihood of sepsis in a healthy infant with isolated fever is low especially when the neonate is:
- previously healthy with no prenatal or natal antibiotic treatment
- no chronic illness
- born term
- did not have any evidence of skin, bone, joint, or ear infection
- laboratory values and blood culture were normal
Among newborns with no risk factors for infection presenting with isolated jaundice, the risk of sepsis is 3.9%.
likelihood of developing sepsis in an otherwise healthylooking newborns with isolated jaundice is low, especially when the neonate:
- has no other risk factors for developing sepsis
- has negative blood culture result
- has negative urine cultures
- has negative CSF cultures
