The challenges of neonatal sepsis management / Os desafios no manejo da sepse neonatal

Abstract Objectives To present current evidence on the etiology, risk factors, diagnosis, and management of early and late neonatal sepsis. Source of data Non-systematic review of the Medline (PubMed), Scopus, Web of Science, Cochrane, and Google Scholar databases regarding the following terms: neonatal sepsis, early neonatal sepsis, late neonatal sepsis, empirical antibiotic therapy, sepsis calculator, vancomycin, newborn, preterm newborn. Data synthesis Neonatal sepsis is a frequent cause of neonatal morbidity and mortality. Its diagnosis is difficult. Continuous observation of the patient is critical to diagnostic suspicion. When neonatal sepsis is suspected, bacteriological tests should be collected. Vancomycin should not be routinely using in the empirical antibiotic regimen in late neonatal sepsis, and the main protective mechanisms against neonatal sepsis are handwashing and the use of breast milk. Conclusions Newborns constitute a group that is more vulnerable to sepsis. Knowledge of risk factors and etiological agents allows a better approach to the newborn with sepsis.

Resumo Objetivos Apresentar evidências atuais na etiologia, fatores de risco, diagnóstico e manejo da sepse neonatal precoce e tardia. Fontes de dados Revisão não sistemática feita nas bases de dados Medline (PubMed), Scopus, Web of Science, Cochrane, Google Scholar sobre os temas sepse neonatal, sepse neonatal precoce, sepse neonatal tardia, antibioticoterapia empírica, sepsis calculator, vancomicina, recém-nascido, recém-nascido pré-termo. Síntese de dados A sepse neonatal é uma causa frequente de morbimortalidade neonatal. O seu diagnóstico é difícil. A observação contínua do paciente é fundamental para uma suspeição diagnóstica. Ao se suspeitar de sepse neonatal devem-se coletar exames bacteriológicos. Não usar, rotineiramente, vancomicina no esquema empírico de antibiótico na sepse neonatal tardia. Os principais mecanismos protetores da sepse neonatal são a lavagem de mãos e o uso do leite materno. Conclusões Os recém-nascidos constituem um grupo mais vulnerável à sepse. O conhecimento dos fatores de risco e dos agentes etiológicos permite uma melhor abordagem do recém-nascido séptico.

The comparison between management recommendations of the Neonatal Early Onset Sepsis Calculator and CDC/AAP guidelines among culture-proven early onset sepsis admitted at University of East Ramon Magsaysay Memorial Medical Center from January 2013 to December 2017 / The Health Sciences Journal

INTRODUCTION Early onset sepsis is difficult to diagnose due to nonspecific symptoms and a lack ofreliable tests. It can progress quickly, and lead to neurodevelopmental consequences or be fatal if nottreated. However, approximately 10-fold more newborns are treated with antibiotics empirically and oftenunnecessarily. This study aimed to compare the management recommendations of the Neonatal EarlyOnset Sepsis Calculator with those of the Centers for Disease Control/American Academy of Pediatricsguidelines.METHODS Neonatal Early Onset Sepsis Calculator was applied to the data set to examine how an alternativemodel would perform compared to current guidelines published by the CDC and compared to currentpractice within the institution. Chi square and kappa value agreement was used to determine the differencebetween treatment recommendations of NEOS calculator and AAP guideline.RESULTS Of the 330 patients who received therapy, only 14.2% were recommended empiric antibiotics bythe EOS calculator, compared to the 39% recommended by the CDC guidelines (p Eleven patients were identified to have culture-positive sepsis.CONCLUSION The number of infants suspected with EOS and subsequently require antibiotic use at birthmay be dramatically reduced with the use of the neonatal EOS calculator.