Don’t start IV antibiotic therapy on well-appearing newborn infants with isolated risk factors for sepsis such as maternal chorioamnionitis, prolonged rupture of membranes, or untreated Group B Streptococcal colonization. Use clinical tools such as an evidence-based sepsis risk calculator to guide management.

Rationale and Comments

Unnecessary exposure of infants to antibiotics is associated with increased parental anxiety, increased length of stay, increased cost, gut microbiome dysbiosis, necrotizing enterocolitis, and possibly allergic and autoimmune diseases. Antibiotic therapy often leads to transfers to higher levels of care and thus decreased maternal-infant bonding. The use of evidence-based sepsis calculators has demonstrated reductions in antibiotic use of 50% or more without a concomitant increase in the incidence of early-onset sepsis.

Sponsoring Organizations

Pediatric Hospital Medicine – SHM, AAP, APA

Sources

American Academy of Pediatrics guidelines

Disciplines

Infectious disease
Neonatology

References

Puopolo KM, et al.; Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of neonates born at ≥35 0/7 weeks' gestation with suspected or proven early-onset bacterial sepsis. Pediatrics. 2018;142(6):e20182894.
Leonardi BM, et al. Utilization of a neonatal early-onset sepsis calculator to guide initial newborn management. Pediatr Qual Saf. 2019;4(5):e214.
Goel N, et al. Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population. Arch Dis Child Fetal Neonatal Ed. 2020;105(2):118-122.
Kaiser Permanente Research. Neonatal Early-Onset Sepsis Calculator. https://neonatalsepsiscalculator.kaiserpermanente.org/