Variation in current management of term and late-preterm neonates at risk for early-onset sepsis: an international survey and review of guidelines

van Herk, Wendy, el Helou, Salhab, Janota, Jan, Hagmann, Cornelia, Klingenberg, Claus, Staub, Eveline, Giannoni, Eric, Tissieres, Pierre, Schlapbach, Luregn J., van Rossum, Annemarie M. C., Pilgrim, Sina B. and Stocker, Martin (2016) Variation in current management of term and late-preterm neonates at risk for early-onset sepsis: an international survey and review of guidelines. Pediatric Infectious Disease Journal, 35 5: 494-500. doi:10.1097/INF.0000000000001063


Author van Herk, Wendy
el Helou, Salhab
Janota, Jan
Hagmann, Cornelia
Klingenberg, Claus
Staub, Eveline
Giannoni, Eric
Tissieres, Pierre
Schlapbach, Luregn J.
van Rossum, Annemarie M. C.
Pilgrim, Sina B.
Stocker, Martin
Title Variation in current management of term and late-preterm neonates at risk for early-onset sepsis: an international survey and review of guidelines
Journal name Pediatric Infectious Disease Journal   Check publisher's open access policy
ISSN 1532-0987
0891-3668
Publication date 2016-05-01
Year available 2016
Sub-type Article (original research)
DOI 10.1097/INF.0000000000001063
Open Access Status Not yet assessed
Volume 35
Issue 5
Start page 494
End page 500
Total pages 7
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams and Wilkins
Collection year 2017
Language eng
Formatted abstract
Background: Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management.

Methods: A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n = 5) were reviewed and compared with the results of the survey.

Results: 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for 5–7 days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations.

Conclusions: There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.
Keyword Early-onset sepsis
Newborn disease
Sepsis
Biological markers
Sepsis diagnosis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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