Reappraisal of Guidelines for Management of Neonates with Suspected Early-Onset Sepsis

• Published in: The Journal of pediatrics 2015-04, Vol.166 (4), p.1070-1074
• Main Authors: Benitz, William E., MD, Wynn, James L., MD, Polin, Richard A., MD
• Format: Article
• Language: English
• Subjects: Disease Management; Humans; Infant, Newborn; Pediatrics; Practice Guidelines as Topic - standards; Sepsis - therapy; Time Factors
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2014.12.023

Since 1992, professional societies or public health agencies in the United States 1 – 12 and elsewhere 13 – 17 have issued several generations of recommendations for prevention or management of early-onset neonatal sepsis (EOS). Despite those efforts, recommendations remain inconsistent, clarifications are necessary 18 , local adaptations are common 19 , and compliance rates are low 20 . We postulate that lack of consensus, especially regarding postnatal management of the neonate, is largely a result of two sets of factors. First, obstetrical prevention strategies have substantially reduced incidence of EOS, potentially changing the utility of predictive strategies based on risk factors. Second, recent data better delineate relationships among risk factors, clinical signs, and EOS, suggesting that risk predictors may have different utilities in different groups. The purpose of this commentary is to explore these questions and to suggest new approaches to management of newborns who may be at risk for EOS.