Management of Neonates with Suspected or Proven
Early-Onset Bacterial Sepsis The main purpose of the article is to provide a practical and, when possible, evidence-based approach to the diagnosis and management of early-onset sepsis with onset less than three days of age. The key question that the author is addressing is how to identify neonates with a high likelidhood of sepsis promptly and initiating antimicrobial therapy. Distinguishing “high-risk” healthy-appearing infants or infants with clinical signs who do not require treatment and discontinuing therapy once sepsis is deemed unlikely. The most important information to take away from the article is that most infants with early-onset sepsis exhibit abnormal signs in the first 24 hours of life. Most will appear healthy at birth and then develop signs of infection after a variable time period. Every critically ill infant should be evaluated and receive empirical broad-spectrum antibiotics after cultures, even when there are no obvious risk factors for sepsis. The second is identifying healthy appearing neonates with a likelihood of early-onset sepsis. Some risk factors consist of premature rupture of membranes and chorioamnionitits. The greatest risk of early-onset sepsis occurs in infants born to women with chorioamnionitis who are also colonized with GBS and did not receive antibiotics.
The key concepts, diagnosis, and management of neonates with suspected early-onset sepsis is based on scientific principles. Neonatal sepsis is a major cause of morbidity and mortality. To determine if the neonate has sepsis diagnostic test are useful for determining the probability of sepsis but not at identifying infants likely to be infected. Diagnostic testing consist of a blood culture to determine which bacteremia is detected. Urine cultures and superficial body sites, and gastric aspirates and not used to diagnose early onset of sepsis. The optimal treatment of infants with suspected early-onset is broad-spectrum antimicrobial agents. Once the bacteria is determined therapy should be narrowed to that specific agent. If the line of reasoning is taking