Abstract
The neonate is uniquely susceptible to bacterial infections, which can range from a subtle to a flagrant presentation. Early identification and treatment of bacterial infection in the newborn can prevent major complications and often depend on consideration of risk factors—such as chorioamnionitis and prolonged rupture of the membranes—in combination with careful, repeated physical examinations.
This chapter presents cases that illustrate key principles of diagnosing and treating neonatal sepsis and meningitis. It reviews appropriate steps in evaluating a newborn with a history and clinical presentation suggestive of sepsis, including the value of screening laboratory tests, such as C-reactive protein and procalcitonin. The chapter also reviews a significant recent development in the field of neonatal sepsis: introduction of a publicly accessible calculator to quantify a newborn’s risk, based on maternal history and clinical presentation. This sepsis calculator is powered by large clinical datasets and represents an important step forward in the effort to rationally assess the risk of sepsis.
While bacterial infection should be considered early in the evaluation of any baby with an unstable presentation, not all symptomatic newborns require antibiotics. This chapter also aims to discuss the familiar dilemma of when and how to evaluate and empirically treat symptomatic newborns, emphasizing that in some cases—particularly during the first 6 h of life when the physiologic transition may still be occurring—watchful waiting is an appropriate course of action.
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Aagaard K, Ma J, Antony KM, Ganu R, Petrosino J, Versalovic J. The placenta harbors a unique microbiome. Sci Transl Med. 2014;6(237):237ra65.
Schmutz N, Henry E, Jopling J, Christensen RD. Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited. J Perinatol. 2008;28(4):275–81.
Birle A, Nebe CT, Hill S, Hartmann K, Poeschl J, Koch L. Neutrophil chemotaxis in cord blood of term and preterm neonates is reduced in preterm neonates and influenced by the mode of delivery and anaesthesia. PLoS One. 2015;10(4):e0120341.
Levy O. Innate immunity of the newborn: basic mechanisms and clinical correlates. Nat Rev Immunol. 2007;7(5):379–90.
Murgas Torrazza R, Neu J. The developing intestinal microbiome and its relationship to health and disease in the neonate. J Perinatol. 2011;31(Suppl 1):S29–34.
Lal CV, Travers C, Aghai ZH, Eipers P, Jilling T, Halloran B, et al. The airway microbiome at birth. Sci Rep Nat Pub Group. 2016;6(1):31023.
Jackson GL, Rawiki P, Sendelbach D, Manning MD, Engle WD. Hospital course and short-term outcomes of term and late preterm neonates following exposure to prolonged rupture of membranes and/or chorioamnionitis. Pediatr Infect Dis J. 2012;31(1):89–90.
Kjaergaard N, Helmig RB, Schønheyder HC, Uldbjerg N, Hansen ES, Madsen H. Chorioamniotic membranes constitute a competent barrier to group b streptococcus in vitro. Eur J Obstet Gynecol Reprod Biol. 1999;83(2):165–9.
Boldenow E, Jones S, Lieberman RW, Chames MC, Aronoff DM, Xi C, et al. Antimicrobial peptide response to group B Streptococcus in human extraplacental membranes in culture. Placenta. 2013;34(6):480–5.
Wortham JM, Hansen NI, Schrag SJ, Hale E, Van Meurs K, Sánchez PJ, et al. Chorioamnionitis and culture-confirmed, early-onset neonatal infections. Pediatr Am Acad Pediatr. 2016;137(1):e20152323.
Greenberg MB, Anderson BL, Schulkin J, Norton ME, Aziz N. A first look at chorioamnionitis management practice variation among US obstetricians. Infect Dis Obstet Gynecol. 2012;2012(2):628362–9.
Verani JR, McGee L, Schrag SJ. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 2010;59:1–36.
National Collaborating Centre for Women's and Children's Health (UK). Antibiotics for Early-Onset Neonatal Infection. Antibiotics for the prevention and treatment of early-onset neonatal infection. London: RCOG Press; 2012.
Polin RA. Committee on fetus and newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129(5):1006–15.
Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. J Pediatr. 2015;166(4):1070–4.
Berardi A, Buffagni AM, Rossi C, Vaccina E, Cattelani C, Gambini L, et al. Serial physical examinations, a simple and reliable tool for managing neonates at risk for early-onset sepsis. World J Clin Pediatr. 2016;5(4):358–64.
Berardi A, Fornaciari S, Rossi C, Patianna V, Bacchi Reggiani ML, Ferrari F, et al. Safety of physical examination alone for managing well-appearing neonates ≥ 35 weeks' gestation at risk for early-onset sepsis. J Matern Fetal Neonatal Med Informa Healthcare. 2015;28(10):1123–7.
Jan AI, Ramanathan R, Chorioamnionitis CRG. Management of Asymptomatic Infants ≥35 weeks without empiric antibiotics. Pediatrics. 2017;140(1):e20162744.
Sullins AK, Abdel-Rahman SM. Pharmacokinetics of antibacterial agents in the CSF of children and adolescents. Paediatr Drugs. 2013;15(2):93–117.
Hamada S, Vearncombe M, McGeer A, Shah PS. Neonatal group B streptococcal disease: incidence, presentation, and mortality. J Matern Fetal Neonatal Med. 2008;21(1):53–7.
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatr Am Acad Pediatr. 2011;127(5):817–26.
Martin-Ancel A, García-Alix A, Salas S, Del Castillo F, Cabañas F, Quero J. Cerebrospinal fluid leucocyte counts in healthy neonates. Arch Dis Child Fetal Neonatal Ed. 2006;91(5):F357–8.
Srinivasan L, Shah SS, Padula MA, Abbasi S, McGowan KL, Harris MC. Cerebrospinal fluid reference ranges in term and preterm infants in the neonatal intensive care unit. J Pediatr. 2012;161(4):729–34.
Bonsu BK, Harper MB. Corrections for leukocytes and percent of neutrophils do not match observations in blood-contaminated cerebrospinal fluid and have no value over uncorrected cells for diagnosis. Pediatr Infect Dis J. 2006;25(1):8–11.
Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics. 1998;102(4):E41.
Lam HS, Ng PC. Biochemical markers of neonatal sepsis. Pathology. 2008;40(2):141–8.
Schelonka RL, Chai MK, Yoder BA, Hensley D, Brockett RM, Ascher DP. Volume of blood required to detect common neonatal pathogens. J Pediatr. 1996;129(2):275–8.
Connell TG, Rele M, Cowley D, Buttery JP, Curtis N. How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children's hospital. Pediatrics. 2007;119(5):891–6.
Kidszun A, Klein L, Winter J, Schmeh I, Gröndahl B, Gehring S, et al. Viral infections in neonates with suspected late-onset bacterial sepsis-a prospective cohort study. Am J Perinatol. 2017;34(1):1–7.
Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128(5):e1155–63.
Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of risk of early-onset sepsis in newborns >= 34 Weeks' gestation. Pediatrics. Am Acad Pediatr. 2014;133(1):30–6.
Sarkar SS, Bhagat I, Bhatt-Mehta V, Sarkar S. Does maternal intrapartum antibiotic treatment prolong the incubation time required for blood cultures to become positive for infants with early-onset sepsis? Am J Perinatol. 2015;32(4):357–62.
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Hooven, T.A., Polin, R.A. (2019). Neonatal Bacterial Infections. In: Martin, G., Rosenfeld, W. (eds) Common Problems in the Newborn Nursery. Springer, Cham. https://doi.org/10.1007/978-3-319-95672-5_7
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DOI: https://doi.org/10.1007/978-3-319-95672-5_7
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