First name
William
Middle name
E
Last name
Benitz

Title

Diagnostic performance and patient outcomes with C-reactive protein use in early-onset sepsis evaluations.

Year of Publication

2022

Date Published

12/2022

ISSN Number

1097-6833

Abstract

OBJECTIVES: To determine performance of C-reactive protein (CRP) in diagnosis of early-onset sepsis (EOS), and to assess patient outcomes with and without routine use of CRP.

STUDY DESIGN: Retrospective cohort study of infants admitted to two neonatal intensive care units. CRP was routinely used in EOS evaluations during 2009-2014; this period was utilized to determine CRP performance at a cut-off of ≥10 mg/L in diagnosis of culture-confirmed EOS. Routine CRP use was discontinued during 2018-2020; outcomes among infants admitted during this period were compared with those in 2012-2014.

RESULTS: From 2009-2014, 10,134 infants were admitted; 9,103 (89.8%) had CRP and 7,549 (74.5%) had blood culture obtained within 3 days of birth. CRP obtained ±4 hours from blood culture had a sensitivity of 41.7%, specificity 89.9% and positive likelihood ratio 4.12 in diagnosis of EOS. When obtained 24-72 hours after blood culture, sensitivity of CRP increased (89.5%), but specificity (55.7%) and positive likelihood ratio (2.02) decreased. Comparing the periods with (n=4,977) and without (n=5,135) routine use of CRP, we observed lower rates of EOS evaluation (74.5% vs. 50.5%), antibiotic initiation (65.0% vs. 50.8%), and antibiotic prolongation in the absence of EOS (17.3% vs. 7.2%) in the later period. Rate and timing of EOS detection, transfer to a higher level of care, and in-hospital mortality were not different between periods.

CONCLUSIONS: CRP diagnostic performance was not sufficient to guide decision-making in EOS. Discontinuation of routine CRP use was not associated with differences in patient outcomes despite lower rates of antibiotic administration.

DOI

10.1016/j.jpeds.2022.12.007

Alternate Title

J Pediatr

PMID

36529283

Title

Management of Neonates Born at ≤34 6/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis.

Year of Publication

2018

Date Published

2018 Nov 19

ISSN Number

1098-4275

Abstract

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.

DOI

10.1542/peds.2018-2896

Alternate Title

Pediatrics

PMID

30455344

Title

Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis.

Year of Publication

2018

Date Published

2018 Nov 19

ISSN Number

1098-4275

Abstract

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.

DOI

10.1542/peds.2018-2894

Alternate Title

Pediatrics

PMID

30455342

Title

The Term Newborn: Early-Onset Sepsis.

Year of Publication

2021

Number of Pages

471-484

Date Published

2021 Aug

ISSN Number

1557-9840

Abstract

<p>The changing epidemiology of early-onset neonatal sepsis among term infants has required reappraisal of approaches to management of newborn infants at potential risk. As this is now a rare disease, new strategies for reduction in diagnostic testing and empirical treatment have been developed. Adoption and refinement of these strategies should be a priority for all facilities where babies are born.</p>

DOI

10.1016/j.clp.2021.05.003

Alternate Title

Clin Perinatol

PMID

34353576

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