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. Retrospective studies have revealed that antibiotic exposures after birth are associated with multiple subsequent poor outcomes among preterm infants, making the risk/benefit balance of these antibiotic treatments uncertain. 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. Our purpose for this clinical report is to provide a summary of the current epidemiology of preterm neonatal sepsis and provide guidance for the development of evidence-based approaches to sepsis risk assessment among preterm newborn infants.

The incidence of neonatal early-onset sepsis (EOS) has declined substantially over the last 2 decades, primarily because of the implementation of evidence-based intrapartum antimicrobial therapy. However, EOS remains a serious and potentially fatal illness. Laboratory tests alone are neither sensitive nor specific enough to guide EOS management decisions. Maternal and infant clinical characteristics can help identify newborn infants who are at risk and guide the administration of empirical antibiotic therapy. The incidence of EOS, the prevalence and implications of established risk factors, the predictive value of commonly used laboratory tests, and the uncertainties in the risk/benefit balance of antibiotic exposures all vary significantly with gestational age at birth. Our purpose in this clinical report is to provide a summary of the current epidemiology of neonatal sepsis among infants born at ≥35 0/7 weeks' gestation and a framework for the development of evidence-based approaches to sepsis risk assessment among these infants.

<p>This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2020-2021 season.The American Academy of Pediatrics (AAP) recommends routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) pandemic. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference for one product or formulation over another.Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication is recommended for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza. Antiviral treatment may be considered for any previously healthy, symptomatic outpatient not at high risk for influenza complications in whom an influenza diagnosis is confirmed or suspected, if treatment can be initiated within 48 hours of illness onset, and for children whose siblings or household contacts either are younger than 6 months or have a high-risk condition that predisposes them to complications of influenza.</p>

<p>This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccines and antiviral medications in the prevention and treatment of influenza in children during the 2019-2020 season. The American Academy of Pediatrics continues to recommend routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference of one product or formulation over another. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication continues to be recommended for children with suspected or confirmed influenza, particularly those who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza.</p>

<p>Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants. Administration of intrapartum antibiotic prophylaxis is the only currently available effective strategy for the prevention of perinatal GBS early-onset disease, and there is no effective approach for the prevention of late-onset disease. The American Academy of Pediatrics joins with the American College of Obstetricians and Gynecologists to reaffirm the use of universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of intrapartum antibiotic prophylaxis. The purpose of this clinical report is to provide neonatal clinicians with updated information regarding the epidemiology of GBS disease as well current recommendations for the evaluation of newborn infants at risk for GBS disease and for treatment of those with confirmed GBS infection.</p>

<p>The authors of this statement update the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children. Highlights for the upcoming 2018-2019 season include the following:1. Annual influenza immunization is recommended for everyone 6 months and older, including children and adolescents.2. The American Academy of Pediatrics recommends an inactivated influenza vaccine (IIV), trivalent or quadrivalent, as the primary choice for influenza vaccination in children because the effectiveness of a live attenuated influenza vaccine against influenza A(H1N1) was inferior during past influenza seasons and is unknown for this upcoming season.3. A live attenuated influenza vaccine may be used for children who would not otherwise receive an influenza vaccine (eg, refusal of an IIV) and for whom it is appropriate because of age (2 years of age and older) and health status (ie, healthy and without any underlying chronic medical condition).4. All 2018-2019 seasonal influenza vaccines contain an influenza A(H1N1) vaccine strain similar to that included in the 2017-2018 seasonal vaccines. In contrast, the influenza A(H3N2) and influenza B (Victoria lineage) vaccine strains included in the 2018-2019 trivalent and quadrivalent vaccines differ from those in the 2017-2018 seasonal vaccines.a. Trivalent vaccines contain an influenza A(Michigan/45/2015[H1N1])pdm09-like virus, an influenza A(Singapore/INFIMH-16-0019/2016[H3N2])-like virus (updated), and an influenza B (Colorado/60/2017)-like virus (B/Victoria lineage; updated).b. Quadrivalent vaccines contain an additional B virus (Phuket/3073/2013-like virus; B/Yamagata lineage).5. All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines.6. Pregnant women may receive an influenza vaccine (IIV only) at any time during pregnancy to protect themselves as well as their infants, who benefit from the transplacental transfer of antibodies. Postpartum women who did not receive vaccination during pregnancy should be encouraged to receive an influenza vaccine before discharge from the hospital. Influenza vaccination during breastfeeding is safe for mothers and their infants.7. The vaccination of health care workers is a crucial step in preventing influenza and reducing health care-associated influenza infections because health care personnel often care for individuals at high risk for influenza-related complications.8. Pediatricians should attempt to promptly identify their patients who are suspected of having an influenza infection for timely initiation of antiviral treatment when indicated and on the basis of shared decision-making between each pediatrician and child caregiver to reduce morbidity and mortality. Although best results are seen when a child is treated within 48 hours of symptom onset, antiviral therapy should still be considered beyond 48 hours of symptom onset in children with severe disease or those at high risk of complications (see Table 2 in the full policy statement).</p>

<p>After the introduction of the hepatitis B vaccine in the United States in 1982, a greater than 90% reduction in new infections was achieved. However, approximately 1000 new cases of perinatal hepatitis B infection are still identified annually in the United States. Prevention of perinatal hepatitis B relies on the proper and timely identification of infants born to mothers who are hepatitis B surface antigen positive and to mothers with unknown status to ensure administration of appropriate postexposure immunoprophylaxis with hepatitis B vaccine and immune globulin. To reduce the incidence of perinatal hepatitis B transmission further, the American Academy of Pediatrics endorses the recommendation of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that all newborn infants with a birth weight of greater than or equal to 2000 g receive hepatitis B vaccine by 24 hours of age.</p>

<p>Antimicrobial resistance is one of the most serious threats to public health globally and threatens our ability to treat infectious diseases. Antimicrobial-resistant infections are associated with increased morbidity, mortality, and health care costs. Infants and children are affected by transmission of susceptible and resistant food zoonotic pathogens through the food supply, direct contact with animals, and environmental pathways. The overuse and misuse of antimicrobial agents in veterinary and human medicine is, in large part, responsible for the emergence of antibiotic resistance. Approximately 80% of the overall tonnage of antimicrobial agents sold in the United States in 2012 was for animal use, and approximately 60% of those agents are considered important for human medicine. Most of the use involves the addition of low doses of antimicrobial agents to the feed of healthy animals over prolonged periods to promote growth and increase feed efficiency or at a range of doses to prevent disease. These nontherapeutic uses contribute to resistance and create new health dangers for humans. This report describes how antimicrobial agents are used in animal agriculture, reviews the mechanisms of how such use contributes to development of resistance, and discusses US and global initiatives to curb the use of antimicrobial agents in agriculture.</p>