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Evaluation of Early Onset Sepsis, Complete Blood Count, and Antibiotic Use in Gastroschisis
Sadie L Williams1, Matthew Leonard1, Eric S Hall1
1Section of Neonatology, Perinatal and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Early-onset sepsis and antibiotic use in infants with gastroschisis may be unnecessary. The immature to mature neutrophil count (I:T) ratio is not a reliable infection marker in these infants.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Infectious Diseases
Background:
- Gastroschisis is a congenital abdominal wall defect.
- Infants with gastroschisis often receive immediate antibiotics post-delivery.
- Infections in this population typically arise from chronic issues, not immediate sepsis.
Purpose of the Study:
- Evaluate the incidence of culture-positive early-onset sepsis in gastroschisis infants.
- Assess the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker.
- Analyze antibiotic use patterns in infants with gastroschisis.
Main Methods:
- Retrospective chart review.
- Analyzed clinical data from 103 infants with gastroschisis.
- Compared with 103 weight-matched control infants evaluated for early-onset infection.
Main Results:
- No culture-positive early-onset sepsis episodes occurred in either group.
- Gastroschisis infants showed a higher percentage of I:T ratio > 0.2 (43% vs. 12%).
- Gastroschisis infants received significantly more antibiotics (>5 days) (75% vs. 6%).
Conclusions:
- The I:T ratio is unreliable for detecting infection in gastroschisis.
- Empiric septic evaluation and immediate antibiotic use may be unnecessary for neonates with gastroschisis.
Objective:
Gastroschisis is a congenital defect in which the abdominal viscera herniate through the abdominal wall. In this population, antibiotics are often initiated immediately following delivery; however, this may be unnecessary as infections typically develop as a consequence of chronic issues in gastroschisis. The objective of this study was to evaluate the incidence of culture positive early onset sepsis, the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker, and antibiotic use in infants with gastroschisis.
Study Design:
This retrospective chart review analyzed clinical data from 103 infants with gastroschisis and 103 weight-matched controls that were evaluated for early onset infection.
Results:
Compared with the control group, there was a significantly increased percentage of infants with an I:T ratio > 0.2 in the gastroschisis group (43% vs. 12%, p < 0.001) and an increased percentage of infants exposed to greater than 5 days of antibiotics regardless of their I:T ratio (75% vs. 6%, p < 0.001). There were no episodes of culture positive early onset sepsis in either group.
Conclusion:
Our results indicate that I:T ratio is not a reliable marker of infection in gastroschisis, and suggest that empiric septic evaluation and antibiotic use, immediately following delivery in gastroschisis infants, may be unnecessary.
