Early-Onset Neonatal Sepsis Study
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Questions and Answers

What is the primary outcome of interest related to early onset sepsis (EOS)?

  • Delivery method used
  • Rupture of membranes at delivery (correct)
  • Absence of intraamniotic infection
  • Cultures growing specific pathogens

What was a significant finding when implementing an algorithm for managing infants suspected of EOS?

  • Increased antibiotic use
  • Decreased need for further testing
  • Decreased adverse events (correct)
  • Increased incidence of infections

What two high-risk perinatal units were included in the study?

  • Pennsylvania Hospital and Hospital of the University of Pennsylvania (correct)
  • City Hospital and County Hospital
  • Children's Hospital and General Hospital
  • Academic Medical Center and Regional Hospital

What was a criterion for considering cultures as contaminants in this study?

<p>Cultures growing known commensal organisms (D)</p> Signup and view all the answers

What was the time frame for infants included in the study?

<p>January 1, 2009 to December 31, 2014 (A)</p> Signup and view all the answers

What outcome was associated with risk prediction models in the study?

<p>Substantial impact on antibiotic use just after birth (C)</p> Signup and view all the answers

What defines empirical antibiotics initiation in this context?

<p>Antibiotic therapy beginning at or before 72 hours after birth (C)</p> Signup and view all the answers

What type of study design was used to gather the data on early onset sepsis?

<p>Retrospective cohort study (D)</p> Signup and view all the answers

What is the significance of the duration of antibiotics in managing early onset sepsis?

<p>It helps in identifying low-risk infants. (C)</p> Signup and view all the answers

Which factor is NOT considered when determining low-risk delivery characteristics?

<p>Presence of gestational age abnormalities (A)</p> Signup and view all the answers

In the context of antibiotics, what does the 'duration in hours' refer to?

<p>Length of time antibiotics need to be administered (A)</p> Signup and view all the answers

Which of the following characteristics increases the likelihood of classifying a delivery as not low-risk?

<p>Labor duration between onset and delivery greater than zero (C)</p> Signup and view all the answers

What element of the study's demographic analysis is highlighted as a distinguishing factor between low-risk and non-low-risk infants?

<p>Gestational age at birth (B)</p> Signup and view all the answers

What design aspect is essential in analyzing the clinical characteristics of infants in the study?

<p>Retrospective cohort study design (C)</p> Signup and view all the answers

What indicates the presence of labor according to the delivery admission reason?

<p>Indications of preterm labor (D)</p> Signup and view all the answers

Which duration classification can indicate a delivery is not low-risk?

<p>Negative duration of ROM (B), ROM duration exceeding 24 hours (D)</p> Signup and view all the answers

What is a key challenge in predicting which infants will develop Early Onset Sepsis (EOS)?

<p>Difficulty in identifying risk factors among preterm infants (A)</p> Signup and view all the answers

What is the primary goal of refining infection risk assessment among neonates?

<p>To identify newborns unlikely to benefit from empirical antibiotic therapy (C)</p> Signup and view all the answers

Which of the following delivery characteristics is hypothesized to indicate low risk for developing EOS?

<p>Birth by cesarean delivery (B)</p> Signup and view all the answers

What is one consequence of prolonged exposure to neonatal antibiotics in preterm infants?

<p>Higher rates of longer-term morbidities (C)</p> Signup and view all the answers

What research method was utilized to gather data on EOS risk in the discussed study?

<p>Chart reviews from existing data repositories (C)</p> Signup and view all the answers

Which of the following is NOT a predicted benefit of improved prediction models for EOS?

<p>Reduced overall costs of neonatal care (C)</p> Signup and view all the answers

What is one potential outcome of incorrectly categorizing delivery risk associated with EOS?

<p>Over-prescription of antibiotics for low-risk infants (C)</p> Signup and view all the answers

Which factor is most likely to reduce the risk of EOS among infants at delivery?

<p>Planned cesarean delivery (B)</p> Signup and view all the answers

Flashcards

EOS in infants

Early-onset sepsis in infants, a difficult condition to predict.

Neonatal care prediction models

Models aiming to predict infants' development of EOS to guide clinical decisions.

Antibiotic use in neonates

High rates of antibiotic use exist in neonatal care, often exceeding necessary proportions.

Prolonged neonatal antibiotic exposure

Extended use of antibiotics during the neonatal period, potentially harming preterm infants.

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Adverse outcomes

Negative consequences resulting from prolonged neonatal antibiotic exposure.

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Infection risk assessment

A need for improved methods to assess infection risk in infants.

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Low-risk delivery characteristics

Defined characteristics, like cesarean delivery and rupture of membranes, associated with a lower risk of early-onset sepsis in infants.

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Infant GA

Gestational age (in completed weeks) of the infant.

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Low-Risk Infants

Infants categorized as having a lower risk due to specific delivery characteristics.

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Empirical antibiotic therapy

Antibiotic treatment based on estimations, possibly unnecessary in some cases.

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Non-Low-Risk Infants

Infants deemed to have a higher risk compared to low-risk infants, indicating potential complications in delivery.

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ROM Duration

Ruptured membranes (rupture of membranes) duration.

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Labor Duration

Time between the onset of labor and delivery.

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Median GA

The middle value of gestational ages of all infants in a group.

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IQR GA

Interquartile range of Gestational Ages.

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Algorithmic approach

A systematic way to determine low-risk delivery characteristics based on various criteria.

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EOS

Early-onset sepsis, defined as at least 1 blood and/or CSF culture obtained 72 hours after birth growing a pathogen.

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Relative risk of EOS

The 5- to 12-fold lower likelihood of developing EOS in infants whose membranes ruptured at delivery, if delivery happened without intra-amniotic infection.

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Empirical antibiotics

Antibiotics given without knowing the exact cause of infection (in this case, related to sepsis).

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Contaminants (cultures)

Cultures growing coagulase-negative Staphylococci or known commensal organisms. They are not indicative of infection.

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Retrospective cohort study

A study that looks back at existing data on a group of people (infants) to find patterns and/or associations.

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Blood Culture

A test to identify the presence of bacteria in the blood.

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Antibiotic use decrease

Implementation of an algorithm to manage infants without antibiotics at birth reduced antibiotic usage in a recent study.

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Risk prediction models

Models that estimate the likelihood of EOS in term infants to improve the approach to EOS risk assessment.

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Study Notes

Delivery Characteristics and Risk of Early-Onset Neonatal Sepsis

  • Multiple strategies are used to identify newborns at high risk of culture-confirmed early-onset sepsis (EOS).
  • Delivery characteristics (e.g., cesarean delivery, no labor, no membrane rupture before delivery, no antepartum concern for intraamniotic infection/nonreassuring fetal status) are used to identify newborns at low risk of infection.
  • Retrospective cohort study of term and preterm infants (Jan 1, 2009 - Dec 31, 2014).
  • Infants had blood cultures within 72 hours of birth.
  • Low EOS risk criteria: cesarean delivery without labor or membrane rupture prior to delivery and without antepartum concern for intraamniotic infection or nonreassuring fetal status.

Study Results

  • Among 53,575 births, 7,549 infants were evaluated.
  • 41 infants (0.5%) had EOS.
  • Low-risk delivery characteristics were present in 1121 infants (14.8% of the evaluated group).
  • None of the low-risk infants developed EOS.
  • Antibiotics were initiated in a lower proportion of low-risk infants (80.4% vs 91.0%, p<.001).
  • Duration of antibiotics was not significantly different between low-risk and non-low-risk infants (adjusted difference 0.6 hours, 95% CI -3.8 to 5.1).

Conclusions

  • Risk of EOS is extremely low in infants with low-risk delivery characteristics.
  • Substantial proportion of these infants still receive antibiotics.
  • Delivery characteristics should be considered when making empirical antibiotic management decisions.

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Delivery Characteristics and the Risk of Early-Onset Neonatal Sepsis PDF

Description

This quiz covers the characteristics and risks associated with early-onset neonatal sepsis (EOS) in newborns. It examines delivery methods and identified strategies for assessing risk factors that can indicate low chances of infection. Key findings from a retrospective cohort study involving over 53,000 births are also discussed.

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