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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Management of term infants at increased risk for early-onset bacterial sepsis

Ann L Jefferies1

  • 1Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario.

Paediatrics & Child Health
|February 27, 2018
PubMed

Insights

Early-onset neonatal bacterial sepsis (EOS) requires prompt management in newborns. Updated guidelines focus on risk factors and empirical antibiotic treatment for unwell infants, emphasizing careful assessment for well-appearing, at-risk newborns.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pediatrics

Background:

  • Early-onset neonatal bacterial sepsis (EOS) is a critical condition in newborns within the first 7 days of life.
  • Maternal Group B streptococcus (GBS) colonization, prolonged rupture of membranes, and maternal fever are key risk factors for EOS.
  • Current laboratory tests lack the sensitivity to reliably rule out EOS in newborns.

Purpose of the Study:

  • To provide updated recommendations for managing term newborns (≥37 weeks' gestational age) at risk of EOS within the first 24 hours of life.
  • To outline strategies for empirical antibiotic treatment and individualized care based on risk factors.

Main Methods:

  • Review and synthesis of current evidence and clinical guidelines for EOS management.
  • Identification of additive risk factors associated with EOS.
  • Development of a management algorithm for at-risk term newborns.

Main Results:

  • Maternal GBS status, prolonged rupture of membranes, and maternal fever are significant additive risk factors for EOS.
  • Empirical antibiotic treatment is crucial for all infants presenting with clinical signs of sepsis.
  • Management of well-appearing, at-risk infants should consider the number of risk factors and intrapartum antibiotic prophylaxis.

Conclusions:

  • Careful assessment and observation are fundamental for managing at-risk newborns.
  • Individualized management plans are necessary for certain cases of neonatal sepsis.
  • Updated recommendations aim to improve the timely and appropriate care of newborns at risk of EOS.

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