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Risks and benefits of investigation and treatment for early onset sepsis
The dilemma facing clinicians over how to approach the investigation of possible early onset neonatal sepsis is perfectly illustrated by the study by Nitin Goel and colleagues and the excellent accompanying editorial by Karen Puopolo. There is no controversy that newborn infants with clinical signs consistent with possible sepsis should be investigated and treated promptly with antibiotics. The question is what should be done for clinically well infants with risk factors? They are at higher risk of becoming ill than the background population but the absolute risk is still low. Large numbers of such infants are screened and treated for every case of proven sepsis. There is likely to be advantage to the infants with infection being treated early while still free of clinical signs, but what about the disadvantages to the large number of infants treated unnecessarily. Goel and colleagues followed the National Institute for Health and Care Excellence (NICE) guideline in a population of 3593 infants born at >34 weeks gestation in eight hospitals in Wales and also assessed what would have been recommended had the infants instead been managed …
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