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OASCN Resources | Early Onset Sepsis Management

These resources were developed by the OASCN Collaborative between 2021-2022.

Relevant Didactics:

  • Use of Inflammatory Markers for Evaluating Early and Late Onset Sepsis (Bill Benitz): Slides | Video
  • Antibacterial Drugs for EOS (Jason Sauberan): Slides | Video
  • Duration of Empiric Antibiotic Therapy for Neonatal Sepsis: How much is Enough? (Ken Zangwill): Slides | Video
  • Antimicrobial Stewardship in Preterm Infants (Bill Benitz): Slides | Video

Relevant Learning Points:

Learning Point #10: The AAP suggests no empiric antibiotics for infants <35 wks gestation delivered by C-section if indicated because of certain maternal indications (e.g., non-infectious illness, placental insufficiency in the absence of labor, attempts to induce labor, or ROM before delivery). Many prescribers are withholding antibiotics in these low-risk preterm infants.

Learning Point #11: The AAP recommends that when blood cultures are sterile, antibiotic therapy should be discontinued by 36-48 hours unless there is clear evidence of site-specific infection for any gestational age.

  • If started, stopping antibiotics in <32 weekers can be done safely (acknowledging that in the SCOUT stewardship study, only 11% were <28 weeks).
  • For ELBW babies only, think about stopping rule out sepsis antibiotics at 24 hours of life instead of 36-48 hours. This is appropriate due to delayed clearance/prolonged antibiotic effect (eg, ampicillin, cefepime).
  • 50 mg/kg/dose of ampicillin is appropriate for bacteremia (vs. 100 mg/kg/dose for meningitis).

Learning Point #12: Viridans streptococcus is often a contaminant that may not require treatment.

Learning Point #13: Emerging robust data suggest prolonged early antibiotic use may lead to unanticipated negative outcomes (related to systemic inflammation).

Learning Point #14: The ACOG approach to “intraamniotic infection” (formerly chorioamnionitis) is worth fully understanding.

Relevant References:

Puopolo KM for COFN and COID. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019;144(2):e20191881.

Puopolo KM for COFN and COID. Management of neonates born at ≥35 0/7 weeks' gestation with suspected or proven early-onset bacterial sepsis. Pediatrics 2018;142:e20182894.

Puopolo KM for COFN and COID. Management of neonates born at ≤34 6/7 weeks' gestation with suspected or proven early-onset bacterial sepsis. Pediatrics 2018;142:e20182896.

Benitz WE et al. Technical assessment of the neonatal early-onset sepsis risk calculator. Lancet Infect Dis. 2020 Oct 29:S1473-3099(20)30490-4. Very deep methodologic dive into the strengths/weaknesses of the Kaiser calculator.

Gong CL et al. Early onset sepsis calculator-based management of newborns exposed to maternal intrapartum fever: a cost benefit analysis. J Perinatology 2019;39:571. Only cost-benefit evaluation of the Kaiser calculator – significantly lowers drug use and societal costs. 

Le J et al. Prolonged post-discontinuation antibiotic exposure in very low birth weight neonates at risk for early-onset sepsis. J Pediatric Infect Dis Soc 2021;10:615-621. Model that shows the prolonged utility of IV ampicillin after discontinuation in VLBWs. 

Berardi A et al. Are postnatal ampicillin levels actually related to the duration of intrapartum antibiotic prophylaxis prior to delivery? A pharmacokinetic study in 120 neonates. Arch Dis Child Fetal Neonatal Ed 2018;103(2).

ACOG’s 2017 view on the treatment of maternal intraamniotic infection