Diagnosis and Treatment of Neonatal Sepsis: Reconciling

the COFN & CDC Guidelines

Ri h d A.
A Polin
P li M.D.
MD
Richard
Morgan Stanley Childrens Hospital
Columbia University

Expert Panels on Neonatal Sepsis

CDC: Centers for Disease
Control and Prevention

COFN: Committee on
Fetus and Newborn
Guidance for the Clinician in
Rendering Pediatric Care

CLINICAL REPORT

Morbidity and Mortality Weekly Report

www.cdc.gov/mmwr

Recommendations and Reports

Management of Neonates With Suspected or Proven

Early-Onset Bacterial Sepsis

November 19, 2010 / Vol. 59 / No. RR-10

Prevention of Perinatal Group B

Streptococcal Disease
Revised Guidelines from CDC, 2010

abstract

Richard A. Polin, MD and the COMMITTEE ON FETUS AND

NEWBORN

KEY WORDS
With improved obstetrical management and evidence-based use of
early-onset sepsis, antimicrobial therapy, group B streptococcus,
intrapartum antimicrobial therapy, early-onset neonatal sepsis is bemeningitis, gastric aspirate, tracheal aspirate, chorioamnionitis,
coming less frequent. However, early-onset sepsis remains one of the
sepsis screen, blood culture, lumbar puncture, urine culture,
body surface cultures, white blood count, acute phase reactants,
most common causes of neonatal morbidity and mortality in the preprevention strategies
term population. The identication of neonates at risk for early-onset
ABBREVIATIONS
sepsis is frequently based on a constellation of perinatal risk factors
CFUcolony-forming units
that are neither sensitive nor specic. Furthermore, diagnostic tests
CRPC-reactive protein
for neonatal sepsis have a poor positive predictive accuracy. As a result,
CSFcerebrospinal uid
GBSgroup B streptococci
clinicians often treat well-appearing infants for extended periods of time,
I/Timmature to total neutrophil (ratio)
even when bacterial cultures are negative. The optimal treatment of
PMNpolymorphonuclear leukocyte
infants with suspected early-onset sepsis is broad-spectrum antimicroPPROMpreterm premature rupture of membranes
bial agents (ampicillin and an aminoglycoside). Once a pathogen is idenThis document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors
tied, antimicrobial therapy should be narrowed (unless synergism is
have led conict of interest statements with the American
needed). Recent data suggest an association between prolonged empirAcademy of Pediatrics. Any conicts have been resolved through
ical treatment of preterm infants (5 days) with broad-spectrum antia process approved by the Board of Directors. The American
biotics and higher risks of late onset sepsis, necrotizing enterocolitis,
Academy of Pediatrics has neither solicited nor accepted any
commercial involvement in the development of the content of
and mortality. To reduce these risks, antimicrobial therapy should be
Richard A. P
this publication.
discontinued at 48 hours in clinical situations in which the probability
NEWBORN
The guidance in this report does not indicate an exclusive
of sepsis is low. The purpose of this clinical report is to provide a
course of treatment or serve as a standard of medical care.
practical
and,
when
possible,
evidence-based
approach
to
the
manageKEY
taking into account individual
may
be WORDS
With improved obstetrical management and Variations,
evidence-based
usecircumstances,
of
appropriate.
ment of infants with suspected or proven early-onset sepsis. Pediatrics
early-onset se
intrapartum antimicrobial therapy, early-onset neonatal sepsis is be2012;129:10061015
meningitis, ga

CLINICAL REPORT

MMWR Recomm Rep. 2010; 59:

1-36.
Continuing Education Examination available at http://w ww.cdc.gov/mmwr/cme/conted.html

department of health and human services

Centers for Disease Control and Prevention

Management of Neonates With Suspec

Early-Onset
Pediatrics. 2012;129(5):
1006-1015.
Bacterial Sepsis
abstract

coming less frequent. However, early-onset sepsis remains one of the

most common causes of neonatal morbidity and mortality in the preINTRODUCTION
term population. The identication of neonates at risk for early-onset

sepsis screen
body surface
prevention str

Epidemiologa
Clinical Spectrum of Early-onset Neonatal Sepsis
EGB el principal patgeno y E. Coli 2 en frecuencia.
There are ~3300 invasive early-onset sepsis cases and 390 deaths in the
United states each year (2005-2008 data).
data)
GBS is the leading pathogen and E coli is second
2/3 E coli isolates are resistant to ampicillin.

Estimacin anual de 3.300 casos, con una mortalidad del 10%.

Black preterm
Non black ppreterm
Black term
Non black term

Rate*
5.14
2.17
0.89
0.04

Case fatality ratio

24.4%
21.5%
1.7%
1.6%
*/1,000 live births

Weston et al Pediatr. Inf Dis. J. 30: 937, 2011

(Rules)

(Guideline)

Recin nacido asintomtico 37 semanas

y factores de riesgo ( corioamnionitis)
CDC
PAI
incompleta

Observacin
(Evaluacin opcional)

COFN

PAI
incompleta
+
HBR 18 h

CDC
Evaluacin limitada

COFN
*Cuando observacin no es posible

Observacin
Evaluacin limitada*

Observacin
Evaluacin limitada*

Yes
Limited evaluation
Either <37 weeks
Yesor duration
Observation for 48 hours
of membrane rupture
18 hours?
Yes
Observation for 48 hours
Mother received intravenous
penicillin, ampicillin,
cefazolin for
4 hoursincludes a blood culture, a complete blood count
* Fullordiagnostic
evaluation
before
delivery?
(CBC) including white blood cell differential and platelet counts, chest ra-

diograph (if respiratory abnormalities are present), and lumbar puncture (if
patient is stableNo
enough to tolerate procedure and sepsis is suspected).
Antibiotic therapy should be directed toward the most common causes of
Morbidity and Mortality Weekly Report
Yes ampicillin
neonatal sepsis, including
intravenous
for GBS
andhours
coverage
for
Observation
for 48
37 weeks and durationwww.cdc.gov/mmwr
other
organisms
(including
Escherichia
coli
and
other
gram-negative
pathoRecommendations
and Reports
November 19, 2010 / Vol. 59 / No. RR-10
of membrane
gens)
and shouldrupture
take into account local antibiotic resistance patterns.
<18 hours?
Consultation
with obstetric providers is important to determine the level of

clinical suspicion
for chorioamnionitis.
Chorioamnionitis
Prevention
of Perinatal
Group B is diagnosed cliniNo
cally and some of
the
signs
are
nonspecific.
Streptococcal Disease
Limited evaluation includes blood culture (at birth) and CBC with differential
Revised
Guidelines
fromhours
CDC,of2010
Yes
and platelets
(at or
birth
and/or at 612
life).
Limited evaluation
Either
<37 weeks
duration
** See table 3 for indications for intrapartum GBS
prophylaxis.
Observation
for 48 hours
of membrane rupture
If signs
of sepsis develop, a full diagnostic evaluation should be conducted
18 hours?
and antibiotic therapy initiated.
If 37 weeks gestation, observation may occur at home after 24 hours if other
discharge criteria have been met, access to medical care is readily available,
* Full
diagnostic
evaluation
includes
blood
culture,
a complete
blood
count
and
a person who
is able to
complyafully
with
instructions
for home
observation will
be present.
any ofcell
these
conditions
is not
met, the
infant
should
(CBC)
including
whiteIfblood
differential
and
platelet
counts,
chest
rabe observed
in the hospital
for at leastare
48present),
hours and
until
discharge
criteria
diograph
(if respiratory
abnormalities
and
lumbar
puncture
(if
are achieved.
patient
is stable enough to tolerate procedure and sepsis is suspected).
Antibiotic
Some experts
recommend
CBC withtoward
differential
and platelets
at causes
age 612
therapy
should bea directed
the most
common
of
hours. sepsis, including intravenous ampicillin for GBS and coverage for
neonatal
other organisms (including Escherichia coli and other gram-negative pathogens) and should take into account local antibiotic resistance patterns.
Consultation with obstetric providers is important to determine the level of
clinical suspicion for chorioamnionitis. Chorioamnionitis is diagnosed clinically and some of the signs are nonspecific.
Continuing Education Examination available at http://w ww.cdc.gov/mmwr/cme/conted.html
Limited
evaluation includes blood culture (at birth) and CBC with differential
and platelets (at birth and/or at 612 hours of life).
** See table department
3 for indications
for intrapartum
GBS
prophylaxis.
of health
and human
services
If signs ofCenters
for Disease
and evaluation
Preventionshould be conducted
sepsis develop,
a fullControl
diagnostic
and antibiotic therapy initiated.
If 37 weeks gestation, observation may occur at home after 24 hours if other
discharge criteria have been met, access to medical care is readily available,
and a person who is able to comply fully with instructions for home observation will be present. If any of these conditions is not met, the infant should

t
F
EFmOJUJPO
PG
BEFRVBUF
JOUSBQBSUVN
BOUJC
prophylaxis, if the infant is well-appearing a
laxis
clarified
asYes4 hours
of IVthe
penicillin,
and 0is days
gestational
age and
duration
Full diagnostic evaluation*
Signs of neonatal sepsis?
cefazolin
before
delivery
(AII).
All other
rupture before
delivery
wasAntibiotic
<18 hours,
then ag
th
therapy
tions
are considered
inadequate
purpose
be observed
for 48 hours,
and nofor
routine
dia
No
management.
is recommended (BIII). If the infant is wellt

8FMMBQQFBSJOH
JOGBOUT
XIPTF
NPUIFS
IBE
BO

Yes
either
<37 weeks
and 0 days
Limitedgestational
evaluation age o
Maternal
chorioamnionitis?
GBS
prophylaxis
but received
no therapy
or inadequat
18
of membrane
rupture
before
delivery
was
Antibiotic
antibiotics
canundergo
be managed
with observation
f
infantNoshould
a limited
evaluation an
unless
infant
is <37 weeks and 0 days g
for 48the
hours
(BIII).
No
befo
membranes
Routine 18
clinical
caremade
GBS or
prophylaxis
indicated were
The
following
keyruptured
changes
werehours
fr
which
case
a
limited
evaluation
and
observa
for
mother?**
guidelines:
is recommended (BIII).
t
hours
F
BMHPSJUIN
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BQQMJFT
UP
BMM
OFXCPSOT
Yes
t

t
8FMMBQQFBSJOH
JOGBOUT
XJUI
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HFTUBUJPOBM
BHF
PG
F
EFmOJUJPO
PG
BEFRVBUF
JOUSBQBSUVN
BOUJ
whose
mothers
received
adequate
intrapartu
Yes4 hours
laxis
is
clarified
as
of
IV
penicillin,

Observation
for
48
hours
Motherprophylaxis
received intravenous
do
not
routinely
require
diagnost
cefazolin
before delivery (AII). All other ag
penicillin,
ampicillin,
(CIII).
tionsforare
considered inadequate for purpos
or cefazolin
4 hours
management.
before delivery?
Monitoring
Implementation
t
8FMMBQQFBSJOH
JOGBOUT
XIPTF
NPUIFS
IBE
BO
No
and
GBS Impact
prophylaxisof
but Guidelines
received no or inadequa
antibiotics can be managed with observation
t
-PDBM
BOE
TUBUF
QVCMJD
IFBMUI
BHFODJFT
JO
DPO
Yes
Observation
48 hours
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weeksforare
and
0
days g
37 weeks
and duration
appropriate
groupsisof<37
hospitals,
encourage
of membrane
rupture for were
or membranes
ruptured
18disease
hoursand
befo
surveillance
early-onset
GBS
<18 hours?
which
a limited
evaluation
and preven
observ
steps
tocase
promote
perinatal
GBS disease
hoursNoistorecommended
(BIII). of early-onset
cation
reduce the incidence
t
in
8FMMBQQFBSJOH
JOGBOUT
XJUI
B
HFTUBUJPOBM
BHF
P
their states (CIII).
whose mothers Yes
received adequate intrapart
Limited evaluation
Either <37
weeks
or
duration
prophylaxis do not routinely
diagnos

Observationrequire
for 48 hours
of membrane rupture
(CIII).
18 hours?

Monitoring Implementation

Rendering Pediatric Care

CLINICAL REPORT

Management of Neonates With Suspected or Proven

Early-Onset Bacterial Sepsis

abstract

Richard A. Polin, MD and the COMMITTEE ON FETUS AND

NEWBORN

With improved obstetrical management and evidence-based use of

intrapartum antimicrobial therapy, early-onset neonatal sepsis is becoming less frequent. However, early-onset sepsis remains one of the
most common causes of neonatal morbidity and mortality in the preterm population. The identication of neonates at risk for early-onset
sepsis is frequently based on a constellation of perinatal risk factors
that are neither sensitive nor specic. Furthermore, diagnostic tests
for neonatal sepsis have a poor positive predictive accuracy. As a result,
clinicians often treat well-appearing infants for extended periods of time,
even when bacterial cultures are negative. The optimal treatment of
infants with suspected early-onset sepsis is broad-spectrum antimicrobial agents (ampicillin and an aminoglycoside). Once a pathogen is identied, antimicrobial therapy should be narrowed (unless synergism is
needed). Recent data suggest an association between prolonged empirical treatment of preterm infants (5 days) with broad-spectrum antibiotics and higher risks of late onset sepsis, necrotizing enterocolitis,
and mortality. To reduce these risks, antimicrobial therapy should be
discontinued at 48 hours in clinical situations in which the probability
of sepsis is low. The purpose of this clinical report is to provide a
practical and, when possible, evidence-based approach to the management of infants with suspected or proven early-onset sepsis. Pediatrics
2012;129:10061015

KEY WORDS
early-onset sepsis, antimicrobial therapy, group B streptococcus,
meningitis, gastric aspirate, tracheal aspirate, chorioamnionitis,
sepsis screen, blood culture, lumbar puncture, urine culture,
body surface cultures, white blood count, acute phase reactants,
prevention strategies

Algoritmos de manejo del recin nacido:

1. Evaluacin Recin nacido asintomOco con factor de riesgo:

CorioamnioniOs materna.
ABBREVIATIONS
CFUcolony-forming units
CRPC-reactive protein
CSFcerebrospinal uid
GBSgroup B streptococci
I/Timmature to total neutrophil (ratio)
PMNpolymorphonuclear leukocyte
PPROMpreterm premature rupture of membranes

2. Evaluacin Recin nacido asintomOco 37 semanas con factor

de riesgo: CorioamnioniOs materna.
This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors
have led conict of interest statements with the American
Academy of Pediatrics. Any conicts have been resolved through
a process approved by the Board of Directors. The American
Academy of Pediatrics has neither solicited nor accepted any
commercial involvement in the development of the content of
this publication.

3. Evaluacin Recin nacido asintomOco 37 semanas con factor

de riesgo: CorioamnioniOs materna.
INTRODUCTION
Suspected sepsis is one of the most common diagnoses made in the
NICU.1 However, the signs of sepsis are nonspecic, and inammatory
syndromes of noninfectious origin mimic those of neonatal sepsis. Most
infants with suspected sepsis recover with supportive care (with or

The guidance in this report does not indicate an exclusive

course of treatment or serve as a standard of medical care.
Variations, taking into account individual circumstances, may be
appropriate.

Pediatrics. 2012;129(5): 1006-1015.

Evaluacin Recin nacido asintomtico

Factor de riesgo: Corioamnionitis

CorioamnioniOs*

HemoculOvo al nacer
Hemograma PCR
6-12 horas de vida

ATB amplio
espectro

Evaluacin

HemoculOvo
posiOvo

ConOnuar ATB
Puncin lumbar

HemoculOvo negaOvo
EF normal
Laboratorio anormal

ConOnuar ATB
48-72 horas
si la madre ATB
durante el parto

HemoculOvo negaOvo
EF normal
Laboratorio normal

Suspender ATB
48 horas

Interpre5ng Complete Blood Counts Soon A:er Birth

In Newborns at Risk for Sepsis
Leucocitos

Neutrfilos

selected f
masked th
tational ag
as eviden
for infants
to 3667 w
with a ges

Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic

Neonates Exposed to Suspected Chorioamnionitis?
Gregory L. Jackson, William D. Engle, Dorothy M. Sendelbach, Debra A. Vedro, Sue
Josey, Jodi Vinson, Carol Bryant, Gary Hahn and Charles R. Rosenfeld
Pediatrics 2004;113;1173

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/113/5/1173.full.html

Indice I/T

Plaquetas

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2004 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Third, al
study, th
age at the
vals of te
LR we r
smaller s
cases to
around th
to stratify
unable to
cific comb

Downloaded from pediatrics.aappublications.org at Hospital Virgen de la Salud Biblioteca on January 2, 2013

FIGURE 2

ROC curves for WBC counts (A), ANCs (B), I/T ratio (C), and platelet counts (D) performed at !72 hours
Newman et al. Pediatrics 126: 903-90, 2010
according to age at the time of the CBC.

Are Complete Blood Cell Counts Useful in the Evaluation of

Asymptomatic Neonates Exposed to Suspected Chorioamnionitis?

Gregory L. Jackson, MD, MBA*; William D. Engle, MD*; Dorothy M. Sendelbach, MD*;
bra A. Vedro, PNP; Sue Josey, PNP; Jodi Vinson, PNP; Carol Bryant, PNP; Gary Hahn, PNP; and
Charles R.ofRosenfeld,
MD* Neutrophil Values in Infants Born
Distribution
Abnormal

Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic

Neonates Exposed to Suspected Chorioamnionitis?
Gregory L. Jackson, William D. Engle, Dorothy M. Sendelbach, Debra A. Vedro, Sue
Josey, Jodi Vinson, Carol Bryant, Gary Hahn and Charles R. Rosenfeld
Pediatrics 2004;113;1173

to Women with Chorioamnionitis

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/113/5/1173.full.html

STRACT. Objective. Chorioamnionitis complicates Eight required rehospitalization; none had evidence of
to 10% of pregnancies and increases the risk of neo- bacterial infection. If neutrophil values had been used to
l infection. Women with chorioamnionitis%receive
determine duration of%antibiotics,
then local costs
symptomatic
asymptomatic
% would
asymptomatic
apartum antibiotics, often resulting in inconclusive have increased by $76 000
to $425 000 per year. (Schelonka)
(Manroe)
natal blood cultures. Peripheral neutrophil values are
Conclusions. Single or serial neutrophil values do not
d frequently to assist in the
diagnosis of neonatal
I/T-1
42%assist in the diagnosis of early-onset
20% infection or deter- 6%
ction and to determine duration of antibiotics; we mination of duration of antibiotic therapy in asymptom47%atic, culture-negative neonates13%
ght to determine the utilityI/T-2
of this approach.
who are >35 weeks gesethods. A prospective observational study was per- tation
and are delivered of women with suspected
I/T-3
25%
5%
med in 856 near-term/term neonates who were ex- chorioamnionitis. Pediatrics 2004;113:11731180;
intraed to suspected chorioamnionitis. Each received anti- amniotic infection, neutrophil values, complete blood
ics for 48 hours unless clinical infection or positive count, early-onset infection, antibiotic therapy, length of
Jacksonwere
G L et stay,
al Pediatrics
113: 1173, 2004
od cultures occurred. Peripheral neutrophils
resource utilization.
sured serially and analyzed using the reference
ges of Manroe et al; an additional analysis of only the
al neutrophil values used the normal ranges of Sche- ABBREVIATIONS. CDC, Centers for Disease Control and Prevenka et al. Results of neutrophil analyses were not used tion; CBC, complete blood cell count; ATN, absolute total neutrophil count; ATI, immature neutrophil count; I:T, immature neuetermine duration of therapy. Fifty percent of asymp- trophil count:absolute total neutrophil count proportion; NBN,
atic neonates were seen postdischarge to ascertain normal newborn nursery; GBS, group B streptococcus.

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2004 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Hospital Virgen de la Salud Biblioteca on January 2, 2013

Recin nacido asintomtico 37 semanas

Factor de riesgo Corioamnionitis
PAI incompleta
o
BR 18 horas

Hemograma PCR
6-12 horas de vida

Observacin
24-48 horas

Evaluacin

Laboratorio anormal

Laboratorio normal
EF normal
Alta a las 48 horas

HemoculOvo

HemoculOvo negaOvo
EF normal
Alta a las 48 horas

HemoculOvo posiOvo

Iniciar ATB
Puncin lumbar

Use of the Complete Blood Cell Count

in Early-onset Neonatal Sepsis

En un estudio con 166.092 neonatos con sospecha de sepsis

neonatal precoz.
Cuando los valores de leucocitos, neutrfilos totales, ndice I/T y
plaquetas fueron normales, solo 0,6% de los neonatos tena un
hemocultivo positivo: VPN del 95%.
Bajas cifras de leucocitos y neutrfilos totales, y altos ndices de I/T
se asocia a un riesgo aumentado de hemocultivo positivo: VPP del
20-40%.

Hornik el al Pediatr. Inf. Dis; 31: 799-802. 2012

Recin nacido asintomtico 37 semanas

Factor de riesgo Corioamnionitis

PAI incompleta
o
BR 18 horas

HemoculOvo
Hemograma PCR
6-12 horas de vida

Evaluacin

Laboratorio
anormal

Laboratorio normal
EF normal
No precisa ATB

ATB amplio espectro

HemoculOvo posiOvo
ConOnuar ATB
Puncin lumbar

HemoculOvo negaOvo
EF normal

Suspender ATB
despus 48-72 horas

Das de tratamiento antibitico

Duration of Antibiotic Therapy
Tratamiento antibitico 5 das, durante los primeros das de vida, ha sido
asociado con incremento de mortalidad, NEC y sepsis neonatal tarda.

OR for NEC,
Com
mpared with Infants w
with
Ze
ero Days on Antibiotic
cs

Prolonged therapy with antibiotics ( 5days) in the first few days of life
has been associated with increased mortality, NEC and late onset sepsis.
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
1 to 2

3 to 4

5 to 6

7 to 8

9 to 10

Days on Antibiotics
Cotten CM and the NICHD Network Pediatrics 123: 58-66, 2009, Kuppala
VS J Pediatr. 159: 720-25, 2011, Vanaja N J Pediatr. 159: 392-97, 2011

>10

Recomendaciones

En pacientes sintomOcos mantener tratamiento anObiOco
durante 7 das.
En 35 semanas y asintomOcos no mantener tratamiento
anObiOco ms de 48 horas.
No existen datos en las guas clnicas para los muy prematuros,
pero recomienda no mantener tratamiento anObiOco ms de 48-72
horas, s los culOvos son negaOvos y el recin nacido se encuentra
asintomOco.

Definicin de corioamnionitis
Definition of Chorioamnionitis
Elevated
cytokines or
amniotic fluid

Histological
Biochemical

Polymorphonuclear
infiltration of
placenta, membranes
and umbilical cord

Microbiological
Maternal fever
tachycardia,
leukocytosis, CRP,
vaginal discharge,
uterine tenderness.
Fetal tachycardia.

Clinical

Fetal
vasculitis
(funisitis)
Neonatal Sepsis

Positive culture
Positive PCR

Corioamnionitis principal factor de riesgo

para sepsis neonatal precoz

RN 37 semanas con el diagnosOco de sepsis neonatal precoz, corioamnioniOs fue

documentada en el 35% (histolgicamente el 90%).

Chorioamnionitis and the Risk of Neonatal Sepsis

in Premature
CorioamnioniOs inversamente
proporcional a Infants
la prematuridad.
22 wk

23 wk

24 wk

25 wk

26 wk

27 wk

28 wk

Histologic
chorioamnionitis

70%

61%

59%

51%

48%

41%

34%

Clinical
chorioamnionitis

28%

26%

20%

19%

19%

15%

14%

4%

4%

2%

2%

2%

1%

Early-onset sepsis 6%

Stoll et al Pediatrics 126: 443-456, 2010

Es5ma5ng the Probability of Neonatal Early-Onset

Infec5on on the basis of Maternal Risk Factor

Modelo predicOvo mulOvariable (6 variables) para esOmar la

Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic

Neonates Exposed to Suspected Chorioamnionitis?
Gregory L. Jackson, William D. Engle, Dorothy M. Sendelbach, Debra A. Vedro, Sue
Josey, Jodi Vinson, Carol Bryant, Gary Hahn and Charles R. Rosenfeld
Pediatrics 2004;113;1173

probabilidad para desarrollar sepsis neonatal precoz en

neonatos 34 semanas.
Calculadora de riesgo de sepsis, disponible en internet.
hfp://www.dor.kaiser.org/external/DORExternal/research/
InfecOonProbabilityCalculator.aspx
Los resultados deben asociarse con la exploracin ksica y los
datos de laboratorio, para ayudar como gua en la toma de
decisiones a la hora de iniciar tratamiento anObiOco.

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/113/5/1173.full.html

}
}
}

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned,
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Puopolo et al. Pediatrics;128:1155-63. 2011

Probability of Neonatal Early-Onset Infection Based on

Maternal Risk Factors for Infants > 34 weeks gestation

Gestational age (weeks/days)

Temperature
ROM (Hours)
GBS status (positive, negative, uncertain)
Maternal intrapartum treatment (GBS specific or broad spectrum)
Was IAP given 4 hours prior to delivery

Predicted probability(/1,000 live births) =

http://www.dor.kaiser.org/external/DORExternal/research/InfectionProbabilityCalculator.aspx
Puopolo et al 2011

Probability of Neonatal Early-Onset Infection Based on

Maternal Risk Factors for Infants > 34 weeks gestation

Gestational age (weeks/days)

Temperature
ROM (Hours)
GBS status (positive, negative, uncertain)
Maternal intrapartum treatment
Was IAP given 4 hours prior to delivery

34 weeks 5 days
99.5 F
12.7 hours
Positive
GBS specific
Yes

Predicted probability(/1,000 live births) =

0.8

http://www.dor.kaiser.org/external/DORExternal/research/InfectionProbabilityCalculator.aspx
Puopolo et al 2011

Conclusiones
Sepsis neonatal precoz causa importante de morbimortalidad
neonatal.
Los algoritmos presentados por COFN son guas orientativas,
influye el arte y la experiencia del Neonatlogo.
Los test de laboratorio son ms tiles para excluir a los recin
nacidos sin infeccin, que para identificar a los infectados.
Los antibiticos deben de suspenderse en 48-72 horas en aquellas
situaciones en las cuales la probabilidad de sepsis es baja.