Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

van Herk, Wendy; El Helou, Salhab; Janota, Jan; Hagmann, Cornelia; Klingenberg, Claus; Staub, Eveline; Giannoni, Eric; Tissieres, Pierre; Schlapbach, Luregn Jan; van Rossum, Annemarie M C; Pilgrim, Sina; Stocker, Martin (2016). Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines". Pediatric infectious disease journal, 35(5), pp. 494-500. Lippincott Williams & Wilkins 10.1097/INF.0000000000001063

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BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine

UniBE Contributor:

Staub, Eveline; Schlapbach, Luregn Jan and Pilgrim, Sina

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0891-3668

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

André Schaller

Date Deposited:

12 May 2016 10:11

Last Modified:

01 Jun 2017 02:30

Publisher DOI:

10.1097/INF.0000000000001063

PubMed ID:

26766143

BORIS DOI:

10.7892/boris.80263

URI:

https://boris.unibe.ch/id/eprint/80263

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