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GUIDELINE OBJECTIVE(S)
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Review risk factors, clinical presentation, evaluation, and treatment options for sepsis in neonates.
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Sepsis is a clinical syndrome caused by invasion of a microbial pathogen into the bloodstream. Early-onset neonatal sepsis (EOS) is defined as onset of symptoms before 7 days of age, while late-onset neonatal sepsis (LOS) refers to the onset of symptoms after 7 days and up to 3 months of age. Suspected sepsis, presumed sepsis, and “rule-out” sepsis are common diagnoses in neonatal intensive care units (NICUs).
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The overall incidence of neonatal sepsis ranges from 1 to 10 cases/1000 live births, with higher incidence observed in lower-birth-weight infants, and in lower-income versus higher-resourced countries. The incidence of EOS has decreased in developed countries with the use of intrapartum Group B Streptococcus (GBS) prophylaxis. In the United States, while the incidence of EOS is less than 1 per 1000 live births, about 35% of extremely low birth weight (ELBW) (<1000 g birth weight) infants in the NICU develop LOS. In low-income countries, the burden of EOS and LOS remains high.
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Pathogens vary across geographic regions. GBS and Escherichia coli are the most common causes of EOS in the United States. Listeria monocytogenes is a rare cause of EOS. In the developing world, Klebsiella, E. coli, staphylococci, and streptococci are prevalent. In term infants, LOS is usually caused by GBS, E. coli, or other gram-negative organisms. In low birth weight infants in the NICU, about 50% cases of LOS are caused by coagulase-negative Staphylococcus (CONS) species, about 25% caused by other gram-positive organisms (S. aureus, Enterococcus, or GBS), 20% by gram-negative organisms (E. coli, Klebsiella, Serratia, Pseudomonas, Acinetobacter, Enterobacter) and about 10% by Candida. The common pathogens causing EOS or LOS are listed in Table 41.1. Mortality is highest with gram-negative bacterial and fungal infections.
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