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Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines

Journal of Perinatology volume 33, pages 198–205 (2013)Cite this article

Subjects

Abstract

Objective:

To determine (a) the proportion of asymptomatic infants born at ⩾35 weeks gestation evaluated for early-onset sepsis (EOS) and exposed to postnatal antibiotics; (b) reasons for and outcomes of the evaluations, and (c) anticipated changes when applying the Centers for Disease Control and Prevention (CDC) 2010 guidelines to this study population.

Study Design:

Retrospective cohort study of infants born at ⩾35 weeks gestation in 2008–2009 in a large maternity center.

Result:

Out of the 7226 infants that met the study criteria: 1062 (14.7%) were evaluated for EOS and half of those evaluated, received empiric antibiotics. 70.4% of evaluations were performed owing to maternal intrapartum fever, but 23% were prompted by inadequate Group B Streptococcus (GBS) prophylaxis alone. Three cases of blood culture-proven infection were identified.

Conclusion:

Improved approaches are needed to identify asymptomatic infants who are at risk for EOS to decrease unnecessary evaluations and antibiotic exposure. Transition to the 2010 CDC GBS guidelines may eliminate a quarter of EOS evaluations among these infants.

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Acknowledgements

We thank the Dr Ruth Tuomala and Dr Alison Cape for the obstetrical contributions to the study; the Centers for Clinical Excellence at Brigham and Women's Hospital for hospital demographic information; and Dr Stella Kourembanas, the Division of Newborn Medicine at Children's Hospital and the Scholars in Clinical Science Program for ongoing support of Dr Mukhopadhyay.

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Authors and Affiliations

  1. Division of Newborn Medicine, Children's Hospital Boston, Boston, MA, USA

    S Mukhopadhyay & K M Puopolo

  2. Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center, Houston, TX, USA

    E C Eichenwald

  3. Channing Laboratory 181 Longwood Avenue, Boston, MA, USA

    K M Puopolo

  4. Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA

    K M Puopolo

  5. Harvard Medical School, Boston, MA, USA

    S Mukhopadhyay & K M Puopolo

Authors
  1. S Mukhopadhyay
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  2. E C Eichenwald
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  3. K M Puopolo
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Correspondence to K M Puopolo.

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Mukhopadhyay, S., Eichenwald, E. & Puopolo, K. Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines. J Perinatol 33, 198–205 (2013). https://doi.org/10.1038/jp.2012.96

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