What's the harm? Risks and benefits of evolving rule-out sepsis practices

Journal of Perinatology : Official Journal of the California Perinatal Association
Thomas A HoovenRichard A Polin

Abstract

Asymptomatic term and late-preterm newborns with risk factors for early onset sepsis commonly undergo laboratory evaluation and receive empiric antibiotic therapy. Some have challenged the rationale for current "rule-out sepsis" practices, arguing that they lead to unnecessary overtreatment and healthcare costs. A series of recent clinical studies has explored scheduled serial observations as an alternative to laboratory testing and empiric antibiotics for asymptomatic newborns with historical risk factors for sepsis. These studies have shared the conclusion that serial observation is safe and cost-effective for well-appearing term and late-preterm babies, but they are also somewhat speculative because culture-proven early onset sepsis is an extremely low prevalence diagnosis. Here, we review the evolving consensus of optimal rule-out sepsis practices. We examine chorioamnionitis as an example of a problematic risk factor that has contributed to the controversy surrounding this topic. We also discuss how introduction of online sepsis risk calculators has allowed more precise delineation of a patient's chances of developing culture-proven infection. Finally, we analyze existing data from published studies to estimate the number ...Continue Reading

References

Jan 1, 1988·Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN·C R Tobin
Sep 1, 1988·American Journal of Diseases of Children·R V Johnson, S M Donn
Feb 1, 1996·Obstetrics and Gynecology·M K YanceyB H Frentzen
Jul 30, 2002·Neonatal Network : NN·L S FranckJ Montgomery
Jun 7, 2003·The Pediatric Infectious Disease Journal·Mary C OttoliniMartin G Ottolini
Aug 6, 2004·American Journal of Obstetrics and Gynecology·Dwight J RouseUNKNOWN National Institute of Child Health And Human Development, Maternal-Fetal Medicine Units Network
Oct 2, 2008·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Francesca GotschSonia S Hassan
Feb 17, 2009·American Journal of Obstetrics and Gynecology·Amuchou S SoraishamUNKNOWN Canadian Neonatal Network
Jun 19, 2009·The New England Journal of Medicine·Melissa K Van DykeStephanie J Schrag
Sep 10, 2010·Infectious Diseases in Obstetrics and Gynecology·Brad BucklerJatinder Bhatia
Apr 2, 2011·Journal of Perinatology : Official Journal of the California Perinatal Association·R Murgas Torrazza, J Neu
Dec 16, 2011·Current Opinion in Microbiology·Jennifer R Robbins, Anna I Bakardjiev
May 2, 2012·Pediatrics·Richard A Polin, UNKNOWN Committee on Fetus and Newborn
Jul 21, 2012·Journal of Perinatology : Official Journal of the California Perinatal Association·S MukhopadhyayK M Puopolo
Sep 4, 2012·Acta Paediatrica·Orna Flidel-RimonEric S Shinwell
Jan 16, 2013·Infectious Diseases in Obstetrics and Gynecology·Mara B GreenbergNatali Aziz
Nov 28, 2013·American Journal of Obstetrics and Gynecology·C Andrew CombsUNKNOWN ProteoGenix/Obstetrix Collaborative Research Network
Dec 25, 2013·Pediatrics·Gabriel J EscobarDavid Draper
Jan 1, 2014·JAMA Pediatrics·Athina PappasUNKNOWN Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Jan 22, 2014·Pediatrics·Sagori MukhopadhyayKaren M Puopolo
Apr 22, 2014·Pediatrics and Neonatology·Fermín García-Muñoz RodrigoCristina Gómez Ospina
May 3, 2014·Journal of Perinatology : Official Journal of the California Perinatal Association·M H Malloy
May 7, 2014·Pediatrics·Courtney KiserZubair H Aghai
Jul 19, 2014·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Alberto BerardiFabrizio Ferrari
Feb 3, 2015·The Journal of Pediatrics·William E BenitzRichard A Polin
Sep 5, 2015·Pediatric Dermatology·Nikolaos KostogloudisNikolaos Nikolaidis
Jan 1, 2016·Pediatrics·Jonathan M WorthamUNKNOWN Eunice Kennedy Shriver NICHD Neonatal Research Network
Feb 9, 2016·Obstetrics and Gynecology·Rosemary D HigginsUNKNOWN Chorioamnionitis Workshop Participants
Jun 18, 2016·The Journal of Vascular Access·Monique LegemaatAgnes van den Hoogen
Nov 23, 2016·World Journal of Clinical Pediatrics·Alberto BerardiFabrizio Ferrari
Feb 28, 2017·JAMA Pediatrics·Michael W KuzniewiczGabriel J Escobar
Jul 26, 2017·Obstetrics and Gynecology·UNKNOWN Committee on Obstetric Practice
Aug 2, 2017·Pediatrics·Thomas A Hooven, Richard A Polin

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Citations

Jun 14, 2018·Neonatology·Alberto BerardiFabrizio Sandri
Jun 7, 2019·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Alberto BerardiLaura Lucaccioni
Dec 19, 2019·Current Opinion in Pediatrics·Alberto BerardiAdam Frymoyer
Aug 15, 2019·BMC Pediatrics·Mitali SahniKaren Shattuck
Jun 30, 2018·Italian Journal of Pediatrics·Alberto BerardiUNKNOWN GBS Prevention Working Group of Emilia-Romagna
Jul 24, 2021·World Journal of Pediatrics : WJP·Gretchen KopecAnirudha Das
Aug 8, 2021·Journal of Perinatology : Official Journal of the California Perinatal Association·Kavita KasatMarty Ellington
Oct 24, 2019·Pediatrics·Joseph SchulmanJeffrey B Gould

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