Management of term infants at increased risk for early-onset bacterial sepsis

Abstract

Early-onset neonatal bacterial sepsis (EOS) is sepsis occurring within the first 7 days of life. This statement provides updated recommendations for the care of term (≥37 weeks' gestational age) newborns at risk of EOS, during the first 24 hours of life. Maternal Group B streptococcus (GBS) colonization in the current pregnancy, GBS bacteriuria, a previous infant with invasive GBS disease, prolonged rupture of membranes (≥18 hours) and maternal fever (temperature ≥38°C) are the factors most commonly associated with EOS. These risk factors are additive; the presence of more than one factor increases the likelihood of EOS. At present, there is no laboratory test, including white blood cell indices, that has sufficient sensitivity to allow clinicians to safely rule out EOS. All unwell infants with clinical signs suggesting sepsis must be treated empirically with antibiotics, once cultures have been taken. The management of well-appearing, at-risk term infants depends on the number of risk factors (including maternal GBS colonization) and whether maternal intrapartum antibiotic prophylaxis for GBS was used. In some cases, management should be individualized. Careful assessment and observation of these at-risk infants are a fundamental component of appropriate care.

Figure 1.

Management of term infants ≥ 37 weeks’ gestational age who are at risk for early onset bacterial sepsis CBC Complete blood count; CXR chest x-ray; GA Gestational age; GBS Group B streptococcus; IAP Intrapartum antibiotic prophylaxis; LP Lumbar puncture