[Clinical observation of newborns with infection risk: A safe practice]

Area of Science:

• Neonatal Medicine
• Pediatric Infectious Diseases
• Clinical Research

Background:

• Early-onset neonatal sepsis is a critical condition with high morbidity and mortality, occurring within the first 72 hours of birth.
• While prevention guidelines have reduced incidence, current international recommendations often involve invasive, painful evaluations for at-risk infants.
• Scientific evidence indicates that infected neonates typically exhibit symptoms within the initial hours post-delivery.

Purpose of the Study:

• To evaluate the safety and efficacy of observing asymptomatic, at-risk infants for early-onset neonatal sepsis.
• To determine if clinical observation alone can reliably detect sepsis in the early hours of life, potentially replacing painful diagnostic tests.

Main Methods:

• A prospective cohort study included 1425 asymptomatic infants born at >35 weeks gestation with risk factors between 2011 and 2015.
• Infants were monitored in the newborn nursery for signs of infection from admission to discharge.
• Data were collected on sepsis incidence and symptom presentation timing.

Main Results:

• Of 9,424 births, 1425 infants met inclusion criteria; 53 were admitted for sepsis evaluation.
• Only 7 infants were diagnosed with sepsis, all presenting symptoms within 72 hours of birth.
• No cases of sepsis were reported in asymptomatic infants during the observation period.

Conclusions:

• Neonates with true early-onset sepsis consistently display symptoms within the first hours of life.
• Clinical observation of at-risk infants is a safe and effective strategy for identifying early-onset sepsis.
• This approach supports a move away from routine painful testing for sepsis evaluation in newborns.