Predicting Neonatal Early Onset Sepsis: A 14-Year Cohort Study

Area of Science:

• Neonatal medicine
• Infectious disease diagnostics
• Pediatric critical care

Background:

• Early onset sepsis (EOS) is suspected in many infants, leading to broad antibiotic use, often unnecessarily.
• Accurate early prediction of culture-proven sepsis (CPS) absence is crucial to limit antibiotic exposure and hospitalization duration.
• Current diagnostic methods for EOS can be slow, delaying critical treatment decisions.

Purpose of the Study:

• To analyze key criteria for predicting the absence of CPS in infants.
• To evaluate the utility of blood culture (BC), C-reactive protein (CRP), and clinical signs at 24 hours post-suspicion for guiding antibiotic discontinuation.
• To improve diagnostic accuracy and reduce unnecessary antibiotic treatment in neonates.

Main Methods:

• Retrospective analysis of infants with suspected EOS from 2007-2020.
• Calculation of proportions of infants with CPS based on positive BC, CRP ≥10 mg/L, and clinical signs at 24 hours.
• Assessment of CRP levels (<10 mg/L) between 12-24 hours in infants without CPS.

Main Results:

• Only 1.2% (50/4120) of infants had CPS.
• A combination of BC, CRP, and clinical signs diagnosed 98% of CPS cases by 24 hours.
• Normal CRP (<10 mg/L) and negative BC at 24 hours allowed for potential antibiotic cessation in 74% of infants.

Conclusions:

• A combined assessment of BC, CRP, and clinical signs at 24 hours post-suspicion is highly effective in diagnosing CPS.
• Early identification of non-septic infants based on these criteria can safely reduce antibiotic treatment duration.
• This approach can significantly decrease antibiotic exposure and length of hospital stay for neonates.