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?

Cultures growing known commensal organisms Signup and view all the answers

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

January 1, 2009 to December 31, 2014 Signup and view all the answers

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

Substantial impact on antibiotic use just after birth Signup and view all the answers

What defines empirical antibiotics initiation in this context?

Antibiotic therapy beginning at or before 72 hours after birth Signup and view all the answers

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

Retrospective cohort study Signup and view all the answers

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

It helps in identifying low-risk infants. Signup and view all the answers

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

Presence of gestational age abnormalities Signup and view all the answers

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

Length of time antibiotics need to be administered Signup and view all the answers

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

Labor duration between onset and delivery greater than zero 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?

Gestational age at birth Signup and view all the answers

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

Retrospective cohort study design Signup and view all the answers

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

Indications of preterm labor Signup and view all the answers

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

Negative duration of ROM Signup and view all the answers

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

Difficulty in identifying risk factors among preterm infants Signup and view all the answers

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

To identify newborns unlikely to benefit from empirical antibiotic therapy Signup and view all the answers

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

Birth by cesarean delivery Signup and view all the answers

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

Higher rates of longer-term morbidities Signup and view all the answers

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

Chart reviews from existing data repositories Signup and view all the answers

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

Reduced overall costs of neonatal care Signup and view all the answers

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

Over-prescription of antibiotics for low-risk infants Signup and view all the answers

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

Planned cesarean delivery Signup and view all the answers

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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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.