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Early-onset sepsis (EOS) remains a serious and often fatal illness among abstract
infants born preterm, particularly among newborn infants of the lowest
gestational age. Currently, most preterm infants with very low birth weight
are treated empirically with antibiotics for risk of EOS, often for prolonged
aDepartment of Pediatrics, Perelman School of Medicine, University
periods, in the absence of a culture-confirmed infection. Retrospective of Pennsylvania, Philadelphia, Pennsylvania; bChildren’s Hospital of
studies have revealed that antibiotic exposures after birth are associated Philadelphia, and dRoberts Center for Pediatric Research, Philadelphia,
Pennsylvania; and cDivision of Neonatal and Developmental Medicine,
with multiple subsequent poor outcomes among preterm infants, making the Department of Pediatrics, School of Medicine, Stanford University, Palo
Alto, California
risk/benefit balance of these antibiotic treatments uncertain. Gestational
age is the strongest single predictor of EOS, and the majority of preterm This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors have
births occur in the setting of other factors associated with risk of EOS, filed conflict of interest statements with the American Academy
of Pediatrics. Any conflicts have been resolved through a process
making it difficult to apply risk stratification strategies to preterm infants. approved by the Board of Directors. The American Academy of
Laboratory tests alone have a poor predictive value in preterm EOS. Delivery Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
characteristics of extremely preterm infants present an opportunity to
Clinical reports from the American Academy of Pediatrics benefit from
identify those with a lower risk of EOS and may inform decisions to initiate expertise and resources of liaisons and internal (AAP) and external
or extend antibiotic therapies. Our purpose for this clinical report is to reviewers. However, clinical reports from the American Academy of
Pediatrics may not reflect the views of the liaisons or the organizations
provide a summary of the current epidemiology of preterm neonatal sepsis or government agencies that they represent.
and provide guidance for the development of evidence-based approaches to The guidance in this report does not indicate an exclusive course of
sepsis risk assessment among preterm newborn infants. treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
REFERENCES
1. Cotten CM, Taylor S, Stoll B, et al; NICHD death for extremely low birth weight birth weight infants. Infect Control
Neonatal Research Network. Prolonged infants. Pediatrics. 2009;123(1):58–66 Hosp Epidemiol. 2003;24(9):662–666
duration of initial empirical antibiotic 2. Cordero L, Ayers LW. Duration of 3. Oliver EA, Reagan PB, Slaughter JL,
treatment is associated with increased empiric antibiotics for suspected Buhimschi CS, Buhimschi IA. Patterns
rates of necrotizing enterocolitis and early-onset sepsis in extremely low of empiric antibiotic administration
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Infectious Disease
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