Evaluating suspected sepsis in term neonates

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• 作者：Paul F. Fleming^a ; Della Forster^a ; ^b ; ^{d.forster@latrobe.edu.au} ; Tracey Savage^a ; Helen Sudholz^a ; Susan E. Jacobs^a ; Andrew J. Daley^a ; ^c ; ^d
• 关键词：Newborn ; Neonate ; Evaluation of early onset sepsis ; Laboratory markers of sepsis ; Antibiotic prophylaxis
• 刊名：Journal of Neonatal Nursing
• 出版年：2012
• 期刊代码：183_13551841
• 类别：med
• 出版时间：June, 2012
• 卷：18
• 期：3
• 页码：98-104
• 文件大小：118 K

摘要

Background

Term newborns commonly undergo evaluations to 鈥榬ule out sepsis鈥? although the frequency of this practice is unknown. Consequences may include increased duration of hospitalisation, admission to the neonatal unit and mother-infant separation, with interrupted breastfeeding.

Method

Newborn infants delivered 鈮?37 weeks gestation without congenital anomalies that had blood cultures performed in January and February 2008 were audited. Sepsis-associated maternal, perinatal and neonatal parameters were collected to classify each infant as having definite, clinical, or no sepsis.

Results

54 of 944 term infants (5.7%) had blood cultures taken to rule out sepsis: 43 (80%) were negative, 11 (20%) had clinical sepsis and none had definite sepsis (3 had contaminants). The majority of evaluations were undertaken in the neonatal unit (59%) or the postnatal ward (34%), with respiratory distress the most frequent indication (38%). Infants with clinical sepsis were more likely to receive resuscitation at birth and to be admitted to the neonatal unit. Of all infants evaluated, 3 received antibiotics for longer than indicated, 1 had antibiotics discontinued early and one infant had antibiotics prescribed that were not optimal.

Conclusions

鈥楻ule out sepsis鈥?evaluations are common. Clinical guidelines together with ongoing education and vigilance regarding blood culture collection as well as choice and duration of antibiotics are important.