This document discusses the epidemiology of neonatal early-onset sepsis (EOS). It reports that:
1) The incidence of EOS is 1-2 cases per 1,000 live births in the US, and 10 times higher for very low birthweight infants.
2) Group B Streptococcus (GBS) has historically been the primary cause of EOS but rates have decreased 80% since widespread use of preventative antibiotics for GBS.
3) Preterm infants now have higher rates of EOS caused by gram-negative bacteria like E. coli, reflecting the changing microbiology with antibiotic use.
This document discusses early onset neonatal sepsis, including definitions, epidemiology, microbiology, risk factors, clinical presentation, evaluation, management, and questions/controversies. Some key points:
- Early onset sepsis occurs within the first 7 days of life and is usually caused by vertical transmission of bacteria from the maternal GI/GU tract. Streptococcus agalactiae (GBS) and Escherichia coli are the most common causes.
- Evaluation involves a sepsis screen including CRP, leukocyte count, blood culture. CRP is elevated in sepsis but also other conditions. A positive blood culture establishes the diagnosis.
- Management consists of supportive care, antimicrobial therapy based on likely pathogens
1. Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection that is an important cause of morbidity and mortality in newborns.
2. The document outlines risk factors, screening protocols, common pathogens, and empirical antibiotic protocols for treating early-onset neonatal sepsis at KIMS hospital in India.
3. Based on local data, the first-line empirical antibiotic recommended for treating suspected early-onset neonatal sepsis at KIMS is amikacin, with pip-tazo as second-line and meropenem or vancomycin as third-line options.
Group B Streptococcus (GBS) is a bacteria that can cause neonatal infections. Studies show the rate of early onset GBS in newborns has declined with the introduction of antibiotic prophylaxis during labor for women with risk factors. Risk factors include premature rupture of membranes, fever, previous GBS-infected baby. Guidelines recommend antibiotics for women in labor with risk factors to prevent transmission of GBS to the newborn around birth.
Management of newborn infant born to mother suffering frommandar haval
Indian J Med Res 140, July 2014, pp 32-39 reviews current recommendations for managing newborn infants born to mothers with tuberculosis. There is no uniform consensus across different countries. Congenital tuberculosis is diagnosed using Cantwell criteria and treated with a 3-4 drug regimen for 9-12 months. Prophylaxis with isoniazid for 3-6 months is recommended for infants born to infectious mothers. Breastfeeding is recommended and isolation is only needed if the mother has multidrug resistant TB or is non-adherent to treatment. The BCG vaccine is given at birth or after prophylaxis completion. Guidelines vary on prophylaxis duration and dose, and timing of diagnostic tests.
Austin Clinical Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all the areas of Clinical Microbiology. Austin Clinical Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of microbiology.
Austin Clinical Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Group B Streptococcus (group B strep) is a type of bacteria that causes illness in people of all ages. Also known as GBS or baby strep, group B strep disease in newborns most commonly causes sepsis (infection of the blood), pneumonia (infection in the lungs), and sometimes meningitis (infection of the fluid and lining around the brain). The most common problems caused by group B strep in adults are bloodstream infections, pneumonia, skin and soft-tissue infections, and bone and joint infections.
Centers for Disease Control and Prevention:
http://www.cdc.gov/groupbstrep/about/index.html
Newborn Sepsis and Group B Streptococcal Infection in PregnancyAngela Amor
This document discusses neonatal sepsis and Group B Streptococcal (GBS) infection in pregnancy. It notes that sepsis is responsible for 36% of the 4 million neonatal deaths annually. GBS is a prominent cause of neonatal sepsis. The document outlines signs and symptoms of early-onset sepsis (EOS) and late-onset sepsis (LOS). It also discusses preventative measures taken, including recommending GBS screening between 35-37 weeks gestation. While a risk-based approach to antibiotic prophylaxis was not as effective, a screened-based strategy where all mothers with a positive GBS screen received treatment was more successful in decreasing EOS incidence.
This document discusses early onset neonatal sepsis, including definitions, epidemiology, microbiology, risk factors, clinical presentation, evaluation, management, and questions/controversies. Some key points:
- Early onset sepsis occurs within the first 7 days of life and is usually caused by vertical transmission of bacteria from the maternal GI/GU tract. Streptococcus agalactiae (GBS) and Escherichia coli are the most common causes.
- Evaluation involves a sepsis screen including CRP, leukocyte count, blood culture. CRP is elevated in sepsis but also other conditions. A positive blood culture establishes the diagnosis.
- Management consists of supportive care, antimicrobial therapy based on likely pathogens
1. Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection that is an important cause of morbidity and mortality in newborns.
2. The document outlines risk factors, screening protocols, common pathogens, and empirical antibiotic protocols for treating early-onset neonatal sepsis at KIMS hospital in India.
3. Based on local data, the first-line empirical antibiotic recommended for treating suspected early-onset neonatal sepsis at KIMS is amikacin, with pip-tazo as second-line and meropenem or vancomycin as third-line options.
Group B Streptococcus (GBS) is a bacteria that can cause neonatal infections. Studies show the rate of early onset GBS in newborns has declined with the introduction of antibiotic prophylaxis during labor for women with risk factors. Risk factors include premature rupture of membranes, fever, previous GBS-infected baby. Guidelines recommend antibiotics for women in labor with risk factors to prevent transmission of GBS to the newborn around birth.
Management of newborn infant born to mother suffering frommandar haval
Indian J Med Res 140, July 2014, pp 32-39 reviews current recommendations for managing newborn infants born to mothers with tuberculosis. There is no uniform consensus across different countries. Congenital tuberculosis is diagnosed using Cantwell criteria and treated with a 3-4 drug regimen for 9-12 months. Prophylaxis with isoniazid for 3-6 months is recommended for infants born to infectious mothers. Breastfeeding is recommended and isolation is only needed if the mother has multidrug resistant TB or is non-adherent to treatment. The BCG vaccine is given at birth or after prophylaxis completion. Guidelines vary on prophylaxis duration and dose, and timing of diagnostic tests.
Austin Clinical Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all the areas of Clinical Microbiology. Austin Clinical Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of microbiology.
Austin Clinical Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Group B Streptococcus (group B strep) is a type of bacteria that causes illness in people of all ages. Also known as GBS or baby strep, group B strep disease in newborns most commonly causes sepsis (infection of the blood), pneumonia (infection in the lungs), and sometimes meningitis (infection of the fluid and lining around the brain). The most common problems caused by group B strep in adults are bloodstream infections, pneumonia, skin and soft-tissue infections, and bone and joint infections.
Centers for Disease Control and Prevention:
http://www.cdc.gov/groupbstrep/about/index.html
Newborn Sepsis and Group B Streptococcal Infection in PregnancyAngela Amor
This document discusses neonatal sepsis and Group B Streptococcal (GBS) infection in pregnancy. It notes that sepsis is responsible for 36% of the 4 million neonatal deaths annually. GBS is a prominent cause of neonatal sepsis. The document outlines signs and symptoms of early-onset sepsis (EOS) and late-onset sepsis (LOS). It also discusses preventative measures taken, including recommending GBS screening between 35-37 weeks gestation. While a risk-based approach to antibiotic prophylaxis was not as effective, a screened-based strategy where all mothers with a positive GBS screen received treatment was more successful in decreasing EOS incidence.
This document provides information about antibiotic resistance in neonatal infections. It discusses the high prevalence of sepsis in newborns, particularly in developing countries like Bangladesh. The most common causative organisms identified in studies from BSMMU NICU are Klebsiella and Acinetobacter. Resistance to first-line antibiotics like ampicillin and gentamicin is widespread. Later studies found increasing resistance even to drugs like meropenem and colistin remains the most effective treatment in many cases. Ongoing surveillance of antibiotic resistance patterns is needed to guide optimal therapy for neonatal sepsis.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
These guidelines provide an overview for investigating and managing infants at risk of congenital syphilis in the Northern Territory of Australia. Risk is determined by the mother's syphilis serology and treatment history. Infants are categorized as no risk, low risk, or high risk. Testing and treatment are tailored based on risk level, with high risk infants receiving more extensive investigations and management through follow up coordinated by local health departments. Interpreting syphilis serology requires knowledge of current clinical information as well as past test results and treatment, and assistance is available from sexual health experts.
Overview presentation: The Burden of Group B Streptococcus Worldwide for Preg...Anjuli Borgonha
This document summarizes a presentation on estimating the global burden of Group B Streptococcus (GBS) disease for pregnant women, stillbirths, and children. It describes the need to estimate the worldwide impact of this leading cause of neonatal infections in high-income countries. A multi-step compartmental model was used to estimate GBS cases, deaths, and disability. Extensive data searches and expert reviews were conducted to gather all available data on GBS colonization, disease outcomes, and risk factors. The challenges of differences in data collection methods and healthcare access across countries are acknowledged. The overall aim is to inform global public health policy, such as the potential development of a maternal GBS vaccine.
The document discusses various topics related to evaluating and managing febrile children, including:
1. Occult bacteremia is a potential cause of fever in young children, with a reported incidence of 1.9-5%. Common organisms include Streptococcus pneumoniae and Haemophilus influenzae.
2. Guidelines for evaluating febrile infants aged 0-3 months include the Philadelphia Protocol and Rochester Protocol, which aim to identify those at low risk of serious bacterial infection.
3. Fever in children with underlying illnesses requires consideration of infection risks specific to their condition, such as opportunistic infections in immunocompromised children.
4. Other conditions like Kawasaki syndrome
Neonatal Fever: An Evidence Based Approachdpark419
1. The document discusses the evaluation and management of febrile infants, with a focus on avoiding unnecessary testing and procedures while not missing serious bacterial infections.
2. There is significant variation in the care of febrile neonates and young infants across pediatric emergency departments, with guidelines recommending full septic workups including blood, urine and CSF testing for infants under 28 days old.
3. Several clinical prediction rules or "low risk" criteria have been developed to determine which febrile infants can be safely managed as outpatients without antibiotics, including the Boston, Philadelphia and Rochester criteria. These criteria focus on patient history, exam findings and laboratory values.
Neonatal sepsis is a clinical syndrome of bacterial infection in infants under 4 weeks old, which can be caused by a variety of bacteria and has risk factors related to the mother's health and birth conditions; it presents with non-specific symptoms affecting multiple organ systems and is diagnosed through blood and cerebrospinal fluid cultures as well as indirect screening tests, being treated with antibiotics and supportive care while preventing hospital-acquired infections through proper hand hygiene.
This document provides an overview and updates on various adult vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). It discusses vaccines for influenza, pneumococcal disease, herpes zoster, Tdap, HPV, meningococcal disease, hepatitis A, and varicella. For each vaccine, it outlines the populations recommended to receive it, dosing schedules, and special considerations for immunocompromised individuals. The presentation emphasizes the importance of adult vaccinations in preventing disease and highlights changes to recommendations for the 2013-2014 season.
This document presents a case of congenital syphilis in a female infant admitted at 1 month of age with bilateral lower limb swelling and redness. The document then provides background information on congenital syphilis including its epidemiology, clinical manifestations, diagnosis and management. It discusses challenges in diagnosis and follow up in resource-limited settings. The case presentation is used to highlight investigations performed and management with penicillin. Follow-up and challenges in Rwanda are also discussed.
The document discusses strategies for preventing perinatal infections. It reviews major bacterial and viral infections, risk factors, diagnostic and treatment approaches, and examples of effective prevention measures. Key prevention strategies include prenatal screening and treatment, vaccination programs, and guidelines for managing at-risk pregnancies and deliveries. National recommendations and monitoring have significantly reduced rates of certain infections.
The document discusses adult immunization, including defining immunization and providing rationales for adult immunization programs. It reviews the disease burden of vaccine-preventable diseases in the US and India and provides recommendations for adult immunization schedules in both countries. Challenges to adult immunization are also discussed.
Congenital Syphilis Epidemiology, Impact and InterventionsDSHS
Congenital syphilis occurs when a pregnant woman with syphilis passes the infection to her fetus. If untreated, it can cause stillbirth, neonatal death, deafness, neurological impairment, or bone deformities in the infant. The document discusses epidemiological data on congenital syphilis and syphilis cases in Texas from 1991-2009 which show high rates compared to national levels. It outlines Texas' plan to reduce congenital syphilis cases by 25% in 5 years through improved surveillance, targeting high-risk populations, promoting screening, and ensuring treatment.
The Febrile Neonate and Young Infant: An Evidence Based Reviewdpark419
Objectives:
1) Discuss the wide variation in management of this patient population
2) Review the low risk criteria for infants deemed safe to be discharged from the emergency room
3) Review the medical evaluation of the febrile neonate and young infant
4) Discuss several difficult clinical situations one may encounter when managing the febrile neonate/young infant (traumatic/dry LP, hyperpyrexia, neonatal mastitis, concomitant viral infection)
5) Answer the question: Can you safely withhold a lumbar puncture from a febrile young infant (4-8 week old)
Adult Vaccination in an ageing society: Immune responseILC- UK
Highlights the importance of vaccinating older people in the context of an ageing society. Sets out how levels of uptake vary across Europe. And highlights ideas for policy makers on how to increase uptake of adult vaccination
Professor Ray Borrow, Head of the Vaccine Evaluation Unit of the Health Protection Agency. Given that prevention in better than cure, Professor Borrow provided an insightful round-up of where we are with vaccination against meningitis and septicaemia. Professor Borrow looked not only at the current vaccine programme in the UK, but also future challenges and vaccination in the developing world, particularly in the sub-Saharan meningitis belt in Africa where disease can affect tens of thousands of people during epidemics years.
GEMC- Fever in the Emergency Department: Special Considerations in Pediatrics...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses vaccinations that are considered safe and not recommended during pregnancy. It states that routine vaccines like diphtheria, tetanus, influenza, hepatitis B, and meningococcal are generally safe during pregnancy. Live virus vaccines for measles, mumps, rubella, varicella, yellow fever, oral polio, and BCG are not recommended due to the theoretical risk of fetal transmission. Inactivated polio and rabies vaccines are also generally considered safe in pregnancy. The risks and benefits of vaccination during each trimester are reviewed for several common diseases.
This document describes the mediastinal lymph node stations according to the 2009 IASLC lymph node map. It provides detailed definitions for each lymph node station, including anatomical boundaries and examples of enlarged lymph nodes in each station seen on CT scans. Key lymph node stations described include supraclavicular (1), superior mediastinal (2-4), aortic (5-6), inferior mediastinal (7-9), hilar (10), interlobar (11), lobar (12), segmental (13), and subsegmental (14) nodes. Diagrams and CT images are provided to illustrate lymph node locations.
This document provides information about antibiotic resistance in neonatal infections. It discusses the high prevalence of sepsis in newborns, particularly in developing countries like Bangladesh. The most common causative organisms identified in studies from BSMMU NICU are Klebsiella and Acinetobacter. Resistance to first-line antibiotics like ampicillin and gentamicin is widespread. Later studies found increasing resistance even to drugs like meropenem and colistin remains the most effective treatment in many cases. Ongoing surveillance of antibiotic resistance patterns is needed to guide optimal therapy for neonatal sepsis.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
These guidelines provide an overview for investigating and managing infants at risk of congenital syphilis in the Northern Territory of Australia. Risk is determined by the mother's syphilis serology and treatment history. Infants are categorized as no risk, low risk, or high risk. Testing and treatment are tailored based on risk level, with high risk infants receiving more extensive investigations and management through follow up coordinated by local health departments. Interpreting syphilis serology requires knowledge of current clinical information as well as past test results and treatment, and assistance is available from sexual health experts.
Overview presentation: The Burden of Group B Streptococcus Worldwide for Preg...Anjuli Borgonha
This document summarizes a presentation on estimating the global burden of Group B Streptococcus (GBS) disease for pregnant women, stillbirths, and children. It describes the need to estimate the worldwide impact of this leading cause of neonatal infections in high-income countries. A multi-step compartmental model was used to estimate GBS cases, deaths, and disability. Extensive data searches and expert reviews were conducted to gather all available data on GBS colonization, disease outcomes, and risk factors. The challenges of differences in data collection methods and healthcare access across countries are acknowledged. The overall aim is to inform global public health policy, such as the potential development of a maternal GBS vaccine.
The document discusses various topics related to evaluating and managing febrile children, including:
1. Occult bacteremia is a potential cause of fever in young children, with a reported incidence of 1.9-5%. Common organisms include Streptococcus pneumoniae and Haemophilus influenzae.
2. Guidelines for evaluating febrile infants aged 0-3 months include the Philadelphia Protocol and Rochester Protocol, which aim to identify those at low risk of serious bacterial infection.
3. Fever in children with underlying illnesses requires consideration of infection risks specific to their condition, such as opportunistic infections in immunocompromised children.
4. Other conditions like Kawasaki syndrome
Neonatal Fever: An Evidence Based Approachdpark419
1. The document discusses the evaluation and management of febrile infants, with a focus on avoiding unnecessary testing and procedures while not missing serious bacterial infections.
2. There is significant variation in the care of febrile neonates and young infants across pediatric emergency departments, with guidelines recommending full septic workups including blood, urine and CSF testing for infants under 28 days old.
3. Several clinical prediction rules or "low risk" criteria have been developed to determine which febrile infants can be safely managed as outpatients without antibiotics, including the Boston, Philadelphia and Rochester criteria. These criteria focus on patient history, exam findings and laboratory values.
Neonatal sepsis is a clinical syndrome of bacterial infection in infants under 4 weeks old, which can be caused by a variety of bacteria and has risk factors related to the mother's health and birth conditions; it presents with non-specific symptoms affecting multiple organ systems and is diagnosed through blood and cerebrospinal fluid cultures as well as indirect screening tests, being treated with antibiotics and supportive care while preventing hospital-acquired infections through proper hand hygiene.
This document provides an overview and updates on various adult vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). It discusses vaccines for influenza, pneumococcal disease, herpes zoster, Tdap, HPV, meningococcal disease, hepatitis A, and varicella. For each vaccine, it outlines the populations recommended to receive it, dosing schedules, and special considerations for immunocompromised individuals. The presentation emphasizes the importance of adult vaccinations in preventing disease and highlights changes to recommendations for the 2013-2014 season.
This document presents a case of congenital syphilis in a female infant admitted at 1 month of age with bilateral lower limb swelling and redness. The document then provides background information on congenital syphilis including its epidemiology, clinical manifestations, diagnosis and management. It discusses challenges in diagnosis and follow up in resource-limited settings. The case presentation is used to highlight investigations performed and management with penicillin. Follow-up and challenges in Rwanda are also discussed.
The document discusses strategies for preventing perinatal infections. It reviews major bacterial and viral infections, risk factors, diagnostic and treatment approaches, and examples of effective prevention measures. Key prevention strategies include prenatal screening and treatment, vaccination programs, and guidelines for managing at-risk pregnancies and deliveries. National recommendations and monitoring have significantly reduced rates of certain infections.
The document discusses adult immunization, including defining immunization and providing rationales for adult immunization programs. It reviews the disease burden of vaccine-preventable diseases in the US and India and provides recommendations for adult immunization schedules in both countries. Challenges to adult immunization are also discussed.
Congenital Syphilis Epidemiology, Impact and InterventionsDSHS
Congenital syphilis occurs when a pregnant woman with syphilis passes the infection to her fetus. If untreated, it can cause stillbirth, neonatal death, deafness, neurological impairment, or bone deformities in the infant. The document discusses epidemiological data on congenital syphilis and syphilis cases in Texas from 1991-2009 which show high rates compared to national levels. It outlines Texas' plan to reduce congenital syphilis cases by 25% in 5 years through improved surveillance, targeting high-risk populations, promoting screening, and ensuring treatment.
The Febrile Neonate and Young Infant: An Evidence Based Reviewdpark419
Objectives:
1) Discuss the wide variation in management of this patient population
2) Review the low risk criteria for infants deemed safe to be discharged from the emergency room
3) Review the medical evaluation of the febrile neonate and young infant
4) Discuss several difficult clinical situations one may encounter when managing the febrile neonate/young infant (traumatic/dry LP, hyperpyrexia, neonatal mastitis, concomitant viral infection)
5) Answer the question: Can you safely withhold a lumbar puncture from a febrile young infant (4-8 week old)
Adult Vaccination in an ageing society: Immune responseILC- UK
Highlights the importance of vaccinating older people in the context of an ageing society. Sets out how levels of uptake vary across Europe. And highlights ideas for policy makers on how to increase uptake of adult vaccination
Professor Ray Borrow, Head of the Vaccine Evaluation Unit of the Health Protection Agency. Given that prevention in better than cure, Professor Borrow provided an insightful round-up of where we are with vaccination against meningitis and septicaemia. Professor Borrow looked not only at the current vaccine programme in the UK, but also future challenges and vaccination in the developing world, particularly in the sub-Saharan meningitis belt in Africa where disease can affect tens of thousands of people during epidemics years.
GEMC- Fever in the Emergency Department: Special Considerations in Pediatrics...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This document discusses vaccinations that are considered safe and not recommended during pregnancy. It states that routine vaccines like diphtheria, tetanus, influenza, hepatitis B, and meningococcal are generally safe during pregnancy. Live virus vaccines for measles, mumps, rubella, varicella, yellow fever, oral polio, and BCG are not recommended due to the theoretical risk of fetal transmission. Inactivated polio and rabies vaccines are also generally considered safe in pregnancy. The risks and benefits of vaccination during each trimester are reviewed for several common diseases.
This document describes the mediastinal lymph node stations according to the 2009 IASLC lymph node map. It provides detailed definitions for each lymph node station, including anatomical boundaries and examples of enlarged lymph nodes in each station seen on CT scans. Key lymph node stations described include supraclavicular (1), superior mediastinal (2-4), aortic (5-6), inferior mediastinal (7-9), hilar (10), interlobar (11), lobar (12), segmental (13), and subsegmental (14) nodes. Diagrams and CT images are provided to illustrate lymph node locations.
A União Europeia está considerando novas regras para veículos autônomos. As regras propostas exigiriam que os fabricantes de veículos autônomos assumam mais responsabilidade por acidentes e garantam que os sistemas de direção sejam projetados para proteger os pedestres e ciclistas. A Comissão Europeia espera que as novas regras ajudem a promover o desenvolvimento seguro de veículos autônomos na UE.
Capitulo 6 apostolado, compromisso e santidade - cópiaKlaus Newman
O documento discute os tópicos de apostolado, compromisso e santidade para liderança na Igreja Católica. Ele explica que líderes devem ser discípulos, ter compromisso com Deus através da fé e oração, e servir como modelos de santidade para os outros, imitando Cristo e cuidando do rebanho de forma desinteressada.
Building A Successful Digital Customer JourneyMiel Van Opstal
The document discusses building a successful digital customer journey. It emphasizes adopting a customer-centric mindset and focusing on solving customer problems, simplifying processes, and connecting with customers. Data from different digital touchpoints should be connected to provide responsive customer experiences and conversion journeys. Inbound marketing strategies, customer-centric content, and smart brand interactions are key, with the goal of owning the relationship between the brand and customers.
As owner of an independent dental practice in Albuquerque, New Mexico, Roderick Garcia, DMD, offers comprehensive dental care for patients of all ages. Roderick Garcia, DMD, draws on extensive experience performing root canals in a comfortable and compassionate environment.
El documento resume los conceptos y teorías fundamentales del psicoanálisis como la existencia de procesos psíquicos inconscientes, la importancia de la sexualidad y el complejo de Edipo. Explica las tópicas de Freud, la técnica psicoanalítica, mecanismos de defensa y desarrollo libidinal. También discute la eficacia del psicoanálisis en el tratamiento de trastornos y su integración con la neurociencia moderna.
Los proyectos de aula en la educación infantilEliza RG
Los proyectos de aula en el grado transición, además de incentivar a los estudiantes para conocer e interactuar con el mundo que los rodea, permite a los docentes reflexionar sobre su practica pedagógica, enriquecerla y brindar herramientas para que cada niño y cada niña sientan deseos de asistir a la escuela y aprender cada día más.
Comandos insert into, update y delete sql serverEdgar Flores
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness and well-being.
This document discusses abdominal compartment syndrome (ACS), which refers to organ dysfunction caused by elevated intra-abdominal pressure. ACS can be primary, due to abdominal injury or disease, or secondary, due to non-abdominal conditions requiring fluid resuscitation. ACS is diagnosed by direct measurement of intra-abdominal pressure and is managed through decompression, usually via decompressive laparotomy. Failure to decompress for ACS leads to high mortality rates.
Clase Sobre el Diseño Web o Desarrollo FronEnd , Tocando temas como su definición, herramientas a utilizar, facetas y tácticas, para ser aplicado a paginas web a traves del HTML5, CSS3, Javascript
Sjogren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands resulting in dry eyes and mouth. It predominantly affects middle-aged women. Approximately one-third of patients experience systemic manifestations such as arthritis, lung involvement, or vasculitis. Pulmonary manifestations include airway disease, interstitial lung disease such as nonspecific interstitial pneumonia, lymphocytic interstitial pneumonitis, and usual interstitial pneumonia. Treatment involves managing dryness symptoms and suppressing inflammation.
Este documento presenta 7 elementos clave para el proyecto de vida y la empresa: interioridad, corporalidad, comunicación, afrontamiento, libertad, trascendencia y acción.
La Unión Europea ha acordado un paquete de sanciones contra Rusia por su invasión de Ucrania. Las sanciones incluyen restricciones a las transacciones con bancos rusos clave y la prohibición de la venta de aviones y equipos a Rusia. Los líderes de la UE esperan que las sanciones aumenten la presión económica sobre Rusia y la disuadan de continuar su agresión contra Ucrania.
La ficha de estudio proporciona instrucciones para los cadetes sobre completar una tarea que incluye identificar la dependencia a la que corresponde el colegio militar, marcar objetos innecesarios en el salón de clase, encerrar normas de convivencia, colorear el escudo del colegio, leer un ejemplo e identificar comportamientos correctos.
BASAMENTO LEGAL QUE RIGE EL SERVICIO COMUNITARIOherlisset
La Constitución del país de 1999 establece el marco legal para el servicio comunitario. Define el servicio comunitario como una actividad no remunerada que realizan los ciudadanos para beneficiar a la comunidad. Establece que todos los ciudadanos entre 18 y 65 años deben completar al menos 40 horas anuales de servicio comunitario.
El documento describe la oxidación del n-butanol a butiraldehído usando dicromato de potasio como agente oxidante. Se explica el mecanismo de reacción y cómo se forma el aldehído deseado evitando su oxidación completa a ácido butanoico. Los resultados muestran que se obtuvo butiraldehído puro con un rendimiento del 97% mediante pruebas con 2,4-dinitrofenilhidrazina que formó un precipitado naranja característico.
El documento presenta información sobre el municipio de Manaure en La Guajira, Colombia. Comienza con una introducción sobre la ubicación, clima y acceso a Manaure. Luego describe brevemente la historia del municipio y algunos detalles geográficos. Más adelante presenta los símbolos de Manaure como el escudo, la bandera e himno. Finalmente, habla sobre la gastronomía, sitios turísticos y cultura de la región caribe colombiana, y concluye resaltando las riquezas naturales y culturales
Приветствуем всех в нашей группе! мы пишем портреты по фото на заказ с гарантией высокой схожести. Чтобы получить консультацию пишите в лс нашему менеджеру https://vk.com/id313342064
Neonatal sepsis is a leading cause of neonatal morbidity and mortality worldwide. Bacteria are the most commonly identified pathogens, including Staphylococcus aureus, Escherichia coli, and Group B Streptococcus. A battery of diagnostic tests were performed on neonates with suspected sepsis, including a complete blood count, C-reactive protein, and polymorphic gastric aspiration cytology. Combining these inexpensive and readily available tests provides high sensitivity and negative predictive value in detecting neonatal sepsis.
Bacterial meningitis in infants under 90 days old remains a significant burden in the UK and Ireland, with approximately 250 cases reported annually. While mortality has decreased over time to around 12%, long-term neurological complications and disabilities persist in around 20-25% of survivors. Effective diagnosis relies on lumbar puncture since clinical signs are non-specific, but many infants do not receive timely lumbar punctures. There is a lack of evidence regarding optimal antibiotic treatment duration and adjunctive therapies. Two ongoing studies aim to better define the current disease burden and identify opportunities to improve outcomes through earlier recognition, management, and prevention.
Bacterial Meningitis in Paediatrics A Review.pdfPUBLISHERJOURNAL
Emmanuel Ifeanyi Obeagu1, Sowdo Abdirizak Mohamed2, Ugwu Okechukwu Paul-Chima3, Getrude Uzoma Obeagu4 and Chukwunalu Igbudu Umoke5
1Department of Medical Laboratory Science, Kampala International University, Uganda.
2Department of Pediatrics, Kampala International University, Uganda.
3Department of Publication and Extension, Kampala International University, Uganda.
4Department of Nursing Science, Kampala International University, Uganda.
5Department of Human Anatomy, Alex Ekwueme Federal University, Ndufu Alike, Ikwo, Ebonyi State, Nigeria.
Email:emmanuelobeagu@yahoo.com
________________________________________
ABSTRACT
Meningitis is a potentially life-threatening condition characterized by infection or inflammation of the central nervous system. It is classified as bacterial, viral, or aseptic. Delayed or untreated bacterial meningitis is associated with high morbidity and mortality. It is important to accurately distinguish between bacterial and nonbacterial meningitis. Most physicians will perform a lumbar puncture and consider antibiotics for all infants and children with suspected meningitis. Having a clinical prediction rule to determine the need for lumbar puncture and which patients need antibiotics could reduce morbidity and the cost associated with unnecessary procedures and treatment. Several clinical prediction rules to determine the risk of bacterial meningitis have been proposed. One clinical prediction rule, derived and validated from cohorts seen in pediatric hospitals in the Netherlands, found that altered consciousness, meningeal irritation, cyanosis, petechiae, vomiting, duration of main symptom, and an elevated C-reactive protein and Erythrocyte Sedimentation Rate level were independent predictors of bacterial meningitis. Patients below a predefined threshold on a risk score incorporating these elements could be safely considered as not having bacterial meningitis.
Keywords: Bacteria, Meningitis, petechiae, C - reactive protein, pediatrics, ESR
This document summarizes key information about neonatal sepsis:
1. Neonatal sepsis is infection in infants less than 28 days old that can cause systemic infection, circulatory shock, and organ failure. Common bacteria include Staphylococcus aureus and Escherichia coli.
2. Risk factors include prolonged hospitalization and use of central venous catheters. Immediate treatment with antibiotics is critical.
3. Blood culture remains the diagnostic standard, but neonates often show only subtle signs initially, like feeding intolerance or abnormal vital signs, making early recognition difficult. A high index of suspicion is important.
This document summarizes information on early-onset neonatal sepsis. It begins by defining sepsis and neonatal sepsis. Neonatal sepsis can be early-onset, occurring within 72 hours of birth due to vertical transmission from the mother, or late-onset, occurring after 3 days of life from environmental sources. The most common causes of early-onset sepsis are Group B Streptococcus and E. coli. Risk factors include maternal colonization or infection and prematurity in the newborn. The document discusses pathogenesis, epidemiology, etiology and clinical presentation of early-onset neonatal sepsis.
1. Necrotizing enterocolitis is an acquired intestinal disease of unknown etiology that commonly affects premature infants. It involves necrosis of the intestinal tissue.
2. The greatest risk factor is prematurity, with risk inversely related to birth weight and gestational age. Other risk factors include genetic factors, indomethacin exposure, maternal cocaine use, G6PD deficiency, H2 blockers, antibiotics like co-amoxiclav, and conditions that decrease mesenteric blood flow.
3. While the exact cause is unknown, factors that may contribute to pathogenesis include genetic susceptibility, ischemic injury from hypotension, and dysregulated intestinal immune response to bacterial colonization in premature infants.
Necrotizing enterocolitis is an acquired intestinal disease of unknown etiology that commonly affects premature infants. The main risk factors are prematurity, genetic factors, maternal health conditions like cocaine use, medications like indomethacin and dexamethasone, and certain enteral feeding practices. The pathogenesis involves an initial hypoxic-ischemic insult to the intestine combined with microbial factors and an excessive inflammatory response that can lead to necrosis of the intestinal tissue. Timely diagnosis and management are important for improving outcomes.
1) The document discusses the current management of occult bacteremia in infants presenting with fever without a source.
2) The prevalence of occult bacteremia has dramatically decreased in recent years due to conjugate vaccines for Streptococcus pneumoniae and Neisseria meningitidis.
3) Urinary tract infection is now the most common bacterial infection found in infants presenting with fever without a source.
Investigating the prevalence of Group B....PROPOSAL.pptxagboolaoe
he incidence of group B Streptococci in pregnant women varies significantly by location, ranging from 13.6% in Windhoek, Namibia, 21.2% in Malawi , 31.6% in Zimbabwe, 37% in South Africa , 1.8% in Mozambique, 15.7% in Ethiopia, 19% in Ivory coast, 22% in Gambia (Haimbodi et al., 2021).
Sepsis remains a major cause of morbidity and mortality among children. While sepsis-associated mortality has decreased significantly from 97% in 1966 to around 10% currently, it remains one of the leading causes of death in children. A recent study found an annual incidence of severe sepsis of 0.56 per 1000 children in the United States, resulting in over 4,000 deaths annually. The most common causes of infection were respiratory tract infections and bloodstream infections. Treatment of sepsis involves prompt administration of antibiotics, supportive care, and treatment of organ dysfunction.
This document discusses necrotizing enterocolitis (NEC) in preterm infants. It notes that NEC is an enigma due to inconsistent definitions and the lumping together of different diseases under the term NEC. There is no clear consensus on what constitutes "classic NEC". The document explores potential causes of NEC like dysbiosis of the gut microbiome from overuse of antibiotics and lack of enteral feeding in preterm infants. It summarizes evidence that common neonatal practices may disrupt the developing microbiome and increase the risk of NEC. While some studies found probiotics reduced NEC rates, the largest and most recent trial found no effect, demonstrating more research is still needed to understand and prevent N
This document discusses the management of neonates with suspected or proven early-onset bacterial sepsis. It provides guidance for clinicians on identifying neonates at high risk for sepsis, distinguishing those who require treatment from healthy-appearing infants, and determining when antimicrobial therapy can be discontinued. The challenges include promptly initiating therapy for infants likely to have sepsis, avoiding unnecessary treatment, and stopping treatment once sepsis is deemed unlikely. The document aims to offer an evidence-based, practical approach to diagnosis and management of early-onset sepsis in newborns.
This study investigated factors associated with latent tuberculosis infection (LTBI) and immune responses to BCG vaccination among children in Uganda. The prevalence of LTBI was 9% at age five years. Urban residence and history of TB contact were positively associated with LTBI. Multiple factors including BCG vaccine strain, LTBI status, HIV infection, helminth infection, and nutrition were associated with cytokine responses at age five. However, cytokine responses at age one year were not predictive of LTBI by age five. While exposure factors dominated the risk of LTBI, the child's immune responses were influenced by various host and environmental factors.
This document summarizes evidence and guidelines around the evaluation and management of possible early-onset neonatal sepsis. It finds that restricting unnecessary evaluation and antibiotics is important. Clinical monitoring can identify red flags and is often sufficient for well-appearing late preterm and term infants, especially with serial exams over 12 hours. While tests have limited predictive value, stopping antibiotics by 36 hours for reassuring infants is recommended. Several adjuvant therapies like exchange transfusions, immunoglobulins, and colony stimulating factors show promise but require more research before routine use.
Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by
setting. Differing estimates of disease burden have been reported from high-income countries compared with reports
from low-income and middle-income countries. The clinical manifestations range from subclinical infection to severe
manifestations of focal or systemic disease. The source of the pathogen might be attributed to an in-utero infection,
acquisition from maternal flora, or postnatal acquisition from the hospital or community. The timing of exposure,
inoculum size, immune status of the infant, and virulence of the causative agent influence the clinical expression of
neonatal sepsis. Immunological immaturity of the neonate might result in an impaired response to infectious agents.
This is especially evident in premature infants whose prolonged stays in hospital and need for invasive procedures
place them at increased risk for hospital-acquired infections. Clinically, there is often little difference between sepsis
that is caused by an identified pathogen and sepsis that is caused by an unknown pathogen. Culture-independent
diagnostics, the use of sepsis prediction scores, judicious antimicrobial use, and the development of preventive
measures including maternal vaccines are ongoing efforts designed to reduce the burden of neonatal sepsis
- Early-onset neonatal sepsis remains a common cause of morbidity and mortality in preterm infants, despite improved obstetric management and antibiotic use.
- The signs and symptoms of neonatal sepsis are nonspecific, and diagnostic tests have poor predictive accuracy, so clinicians often treat infants empirically even when cultures are negative.
- The optimal treatment for suspected early-onset sepsis is broad-spectrum antibiotics like ampicillin and an aminoglycoside, though therapy should be narrowed once a pathogen is identified or discontinued by 48 hours if sepsis is deemed unlikely.
Bacteria Isolated From the Cerebrio-Spinal Fluid (Csf) of Suspected Cases of ...iosrjce
This document summarizes a study that analyzed 742 cerebrospinal fluid (CSF) samples from suspected meningitis cases in Enugu State, Nigeria. 11 samples (1.5%) tested positive for bacteria. The main bacteria isolated were Escherichia coli (36.4%), Neisseria meningitidis (18.2%), Streptococcus pneumoniae (18.2%), Staphylococcus aureus (18.2%), and Pseudomonas aeruginosa (9.1%). 64% of cases were in children under 2 years old. All isolated bacteria were found to be sensitive to cephalosporins.
This document discusses the management of neonatal sepsis and identifies areas of potential malpractice. It presents two case studies of neonates with sepsis that were potentially mismanaged. The document then outlines key topics to be covered, including features of neonatal sepsis, the role of CRP and procalcitonin in diagnosis, treatment planning considerations, controversies around certain drug uses, the role of blood exchange transfusions, and potential adjuvant therapies. Overall, the document aims to improve management of neonatal sepsis by revising basic knowledge around appropriate diagnosis and treatment.
Neonatal infections, especially sepsis, continue to be a significant cause of morbidity and mortality in newborns. Sepsis is caused by microorganisms or their toxins in the blood or tissues. There are two patterns of neonatal bacterial infection - early-onset within 24-48 hours of birth often caused by maternal vaginal flora, and late-onset after 2 weeks of age which may be acquired from the birth canal or external environment. Risk factors include preterm birth, prolonged rupture of membranes, maternal fever or infection. Signs of sepsis include respiratory distress, temperature instability, feeding intolerance and jaundice. Treatment involves administering IV antibiotics and supportive care while monitoring for improvement.
This document discusses a study that tested the hypothesis that changes in the diabetic ocular environment facilitate the development of endogenous bacterial endophthalmitis (EBE). Mice were rendered diabetic for varying durations (1, 3, or 5 months) using streptozotocin injections. Diabetic and non-diabetic mice were then infected with Klebsiella pneumoniae via tail vein injection. Results showed that longer diabetes duration (3-5 months) correlated with higher EBE incidence and greater blood-retinal barrier permeability, supporting the hypothesis that diabetic ocular changes contribute to EBE development.
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Pmk no. 11 ttg pelayanan rawat jalan eksekutif di rs (1)Nazila Hana
Peraturan Menteri Kesehatan ini mengatur tentang penyelenggaraan pelayanan rawat jalan eksekutif di rumah sakit yang memberikan pelayanan kesehatan rawat jalan nonreguler dengan standar yang lebih tinggi untuk meningkatkan akses dan kenyamanan masyarakat. Peraturan ini mengatur persyaratan, pelayanan, pembinaan, dan pengawasan pelayanan rawat jalan eksekutif di rumah sakit.
The document discusses attempts over the last 14 years to improve policy making in the UK government. It identifies four main areas of focus: process, qualities, structures, and politics. While the goals of these reform efforts are widely agreed upon, the document argues there remains a gap between the theory presented and the realities of policy making practice. The two key qualities that have proven most elusive are evaluation, review and learning, and innovation, due to systemic barriers like misaligned timescales, departmental incentives, and lack of clarity over their practical meaning. Overall, while the desire to improve is clear, current approaches have not adequately addressed the challenges of translating theory into reality.
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This document provides an introduction to implementation terms, concepts, and frameworks. It discusses why implementation matters in bridging the gap between evidence and practice. Implementation is defined as carrying out a plan and focuses on operationalizing innovations across multiple levels from systems to individual behavior change. Ireland examples of successful implementation include its road safety policy and Early Childhood Care and Education scheme which demonstrate that strong leadership, coordination between agencies, accountability, and legislation are important for implementation success.
Keputusan menteri kesehatan republik indonesiaNazila Hana
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2. Dokumen tersebut membahas tentang sistem rujukan kesehatan antar fasilitas yang telah diatur dalam peraturan pemerintah terkait BPJS serta peran dan tanggung jawab din
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Epidemiology of Neonatal
Early-onset SepsisKaren M. Puopolo, MD,
PhD*
Author Disclosure
Dr Puopolo has
disclosed no financial
relationships relevant
to this article. This
commentary does not
contain a discussion
of an unapproved/
investigative use of a
commercial product/
device.
Objectives After completing this article, readers should be able to:
1. Describe the incidence and microbiology of neonatal early-onset sepsis (EOS).
2. Identify clinical risk factors for neonatal EOS.
3. Review the impact of group B streptococcal prophylaxis policies on the epidemiology
of neonatal EOS.
4. Delineate the differences in incidence, risk, and microbiology of neonatal EOS between
term and very low-birthweight infants.
Abstract
Neonatal early-onset sepsis (EOS) continues to be a significant source of morbidity
and mortality among newborns, especially among very-low birthweight infants.
Epidemiologic risk factors for EOS have been defined, and considerable resources are
devoted to the identification and evaluation of infants at risk for EOS. The widespread
implementation of intrapartum antibiotic prophylaxis for the prevention of early-
onset neonatal group B Streptococcus (GBS) disease has reduced the overall incidence
of neonatal EOS and influenced the microbiology of persistent early-onset infection.
Most early-onset neonatal GBS disease now occurs in preterm infants or in term
infants born to mothers who have negative GBS screening cultures. Ongoing clinical
challenges include reassessment of clinical risk factors for EOS in the era of GBS
prophylaxis; more accurate identification of GBS-colonized women; and continued
surveillance of the impact of GBS prophylaxis practices on the microbiology of EOS,
particularly among very low-birthweight infants.
Introduction
Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in
newborns, particularly in very-low birthweight (VLBW) infants (birthweight Ͻ1,500 g).
Neonatal early-onset sepsis (EOS) is defined by the Centers for Disease Control and
Prevention (CDC) as blood or cerebrospinal fluid culture-
proven infection occurring in the newborn who is younger
than 7 days of age. (1) For the continuously hospitalized
VLBW infant, EOS is defined as culture-proven infection
occurring at fewer than 72 hours of age. (2) The alternative
definition in VLBW infants is justified by two findings:
1) the risks for infection in VLBW infants after 72 hours of
age primarily derive from the specifics of ongoing neonatal
intensive care rather than from perinatal risk factors, and
2) the organisms causing infection after 72 hours of age
among VLBW infants reflect the nosocomial flora of the
neonatal intensive care unit (NICU) more than perinatally
acquired maternal flora. (2)
The overall incidence of EOS in the United States in the
past 10 years is 1 to 2 cases per 1,000 live births; the
incidence is 10-fold higher in VLBW infants. (3)(4) Since
*Assistant Professor of Pediatrics, Harvard Medical School; Attending Physician, Channing Laboratory and Department of
Newborn Medicine, Brigham and Women’s Hospital and Division of Newborn Medicine, Children’s Hospital, Boston.
Abbreviations
BWH: Brigham and Women’s Hospital
CDC: Centers for Disease Control and Prevention
EOS: early-onset sepsis
GBS: group B Streptococcus
IAP: intrapartum antibiotic prophylaxis
MRSA: methicillin-resistant Staphylococcus aureus
NICHD: National Institute of Child Health and
Development
NICU: neonatal intensive care unit
PCR: polymerase chain reaction
VLBW: very low birthweight
Article infectious disease
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3. the 1970s, the primary pathogen causing EOS in the
United States has been group B Streptococcus (GBS). The
incidence of EOS has fallen with the widespread imple-
mentation of intrapartum antibiotic prophylaxis (IAP)
for the prevention of early-onset GBS disease. The na-
tional incidence of GBS EOS has declined 80% from 1.7
cases per 1,000 live births in 1993 to 0.34 cases per
1,000 live births in 2003 to 2005. (1) Multiple studies
assessing the impact of GBS IAP policies demonstrate
that the incidence of non-GBS EOS is unchanged or
decreasing among term births. (4) Concern remains
about the impact of these policies on the incidence and
microbiology of EOS among VLBW infants.
Bacterial sepsis was the eighth leading cause of death
among newborns in the United States in 2000 to 2001.
(5) Mortality from EOS decreased significantly in term
infants with improvements in NICU care over the past
20 years, primarily due to advances in respiratory support
(including surfactant replacement, high-frequency venti-
lation, inhaled nitric oxide, and extracorporeal mem-
brane oxygenation). Mortality rates from EOS are higher
in preterm infants. The most recent CDC active surveil-
lance data on infants who have early-onset GBS disease
revealed that 2.6% of term infants died of the infection
compared with 19.9% of infants born before 37 weeks’
gestation, an eightfold increase in the risk of infection-
attributable mortality. (1) Among
VLBW infants, mortality is greater:
35% of VLBW infants who had EOS
died in a 2002 to 2003 National In-
stitute of Child Health and Develop-
ment (NICHD) Neonatal Network
cohort study compared with an over-
all 11% mortality among uninfected
VLBW infants. (3) Finally, neonatal
survivors of EOS may have severe
neurologic sequelae, attributable to
concomitant meningitis or from
hypoxemia resulting from septic
shock, persistent pulmonary hyper-
tension, and hypoxic respiratory
failure. Hypotension and increased
concentrations of inflammatory cy-
tokines during sepsis also may in-
jure the developing neonatal cen-
tral nervous system.
Microbiology of EOS
Since the 1980s, GBS has been the
leading cause of neonatal EOS in
the United States. Despite the
widespread implementation of IAP, early-onset GBS dis-
ease remains the leading cause of EOS in term infants
(Table 1). However, coincident with the increased use of
IAP for GBS, gram-negative enteric bacteria have be-
come the leading cause of EOS in preterm infants (Table
2). (3)(4)(6) In Table 1, data from the CDC Active
Bacterial Core Surveillance program are compared with
data from our single center (the Brigham and Women’s
Hospital [BWH]in Boston). The CDC data were ob-
tained from the Atlanta and San Francisco metropolitan
areas in 1998 to 2000. The BWH is a large maternity
hospital that has an average 9,000 deliveries per year. The
BWH data encompass all cases of EOS occurring in
infants cared for in the 50-bed Level III BWH NICU for
the period 1990 to 2007. Both data sets reveal a similar
spectrum of organisms, with a predominance of gram-
positive organisms, primarily GBS and other streptococ-
cal species. Table 2 compares data from the NICHD
Neonatal Network and our single center. The NICHD
data are from 16 centers over the period 2002 to 2003.
Our single-center data include cases of EOS occurring in
infants cared for in the BWH NICU from 1990 to 2007
whose birthweights were less than 1,500 g. Again, the
data sets are strikingly similar, with a predominance of
enteric bacilli, primarily Escherichia coli but including a
spectrum of other Enterobacteriaceae (Klebsiella,
Table 1. Organisms Causing Neonatal Early-onset
Sepsis
Organism
Centers for
Disease Control
and Prevention
(n)804؍ %
Brigham and
Women’s Hospital
(n)703؍ %
GBS 166 40.7 130 42.3
Escherichia coli 70 17.2 64 20.8
Other streptococci* 93 22.7 37 12.1
Enterococcus 16 3.9 13 4.2
Staphylococcus aureus 15 3.7 12 3.9
CONS - - 14 4.6
Listeria 6 1.5 2 0.7
Bacteroides 5 1.2 14 4.6
Klebsiella 9 2.2 4 1.3
Haemophilus influenzae 9 2.2 6 2.0
Other gram-negative†
16 3.9 5 1.6
Other§
3 0.7 6 2.0
Total gram-positive 299 73.3 211 68.7
Total gram-negative 109 26.7 96 31.3
CONSϭcoagulase-negative Staphylococcus, GBSϭgroup B Streptococcus.
*Other streptococci include S pneumoniae, S bovis, S mitis, Peptostreptococcus, and viridans streptococci.
†
Other gram-negative organisms include Pseudomonas, Proteus, Morganella, and Yersinia.
§
Other organisms include Bacillus and Clostridium.
Adapted from Hyde et al. Pediatrics. 2002;110:690–695.
infectious disease sepsis
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4. Pseudomonas, Haemophilus, and Enterobacter sp) and the
anaerobic species Bacteroides.
EOS Caused by GBS
GBS frequently colonizes the human genital and gastro-
intestinal tracts and the upper respiratory tract in young
infants. GBS are facultative diplococci that are primarily
identified by the Lancefield group B carbohydrate anti-
gen. They are subtyped further into nine distinct capsular
polysaccharide serotypes (types Ia, Ib, II, III, IV, V, VI,
VII, VIII). A potential tenth polysaccharide type recently
has been identified. (7) Most GBS EOS in the United
States currently is caused by types Ia, Ib, II, III, and V
GBS. (1) Type III GBS more commonly are associated
with late-onset sepsis and meningitis.
Early-onset GBS infection is acquired in utero or
during passage through the birth canal. Approximately
20% to 30% of American women are colonized with GBS
at any given time. A longitudinal study of GBS coloniza-
tion in a cohort of primarily young, sexually active
women demonstrated that nearly 60% were colonized
with GBS at some time over a 12-month period. (8) In
the absence of IAP, approximately 50% of infants born to
mothers colonized with GBS are colonized at birth, and
1% to 2% of colonized infants develop invasive GBS
disease. Lack of maternally derived
protective capsular polysaccharide-
specific antibody is associated with
the development of invasive GBS
disease. Other factors predisposing
the newborn to GBS disease are less
well understood, but relative defi-
ciencies in complement, neutrophil
function, and innate immunity may
be important.
A number of studies helped de-
fine maternal and neonatal risk fac-
tors for GBS EOS. Benitz and asso-
ciates (9) performed a literature
review and data reanalysis of studies
of risk factors for GBS EOS from
the 1970s to the 1990s to generate
odds ratio estimates for several clin-
ical factors (Table 3). Maternal
GBS colonization alone was far
more predictive than any other ma-
ternal or neonatal clinical character-
istic, a finding that is the evidence
base for the current recommenda-
tion for use of IAP according to
maternal GBS colonization status.
Additional maternal clinical factors predictive of early-
onset GBS disease include maternal intrapartum fever
(temperature Ͼ99.5°F [37.5°C]), the clinical diagnosis
of chorioamnionitis, and prolonged rupture of mem-
branes (Ͼ18 h). Neonatal risk factors include prematu-
rity (Ͻ37 weeks’ gestation) and low birthweight
(Ͻ2,500 g), especially birthweight less than 1,000 g.
Although once considered a risk factor for GBS disease,
Table 2. Organisms Causing Early-onset Sepsis in
Very Low-birthweight Infants
Organism
National Institute
of Child Health
and Development
(n)201؍ %
Brigham and
Women’s Hospital
(n)59؍ %
GBS 12 11.8 20 21.1
Escherichia coli 42 41.2 31 32.6
Other streptococci* 9 8.8 12 12.6
CONS 15 14.7 5 5.3
Listeria 2 2.0 1 1.1
Other gram-positive†
8 7.8 5 5.3
Bacteroides N/A - 9 9.5
Haemophilus influenzae 2 2.0 3 3.2
Enterobacter 4 3.9 1 1.1
Citrobacter 3 2.9 2 2.1
Other gram-negative§
3 2.9 4 4.2
Fungal 2 2.0 2 2.1
Total gram-positive 46 45.1 43 45.3
Total gram-negative 54 52.9 50 52.6
CONSϭcoagulase-negative Staphylococcus, GBSϭgroup B Streptococcus.
*Other streptococci include S pneumoniae, S mitis, viridans streptococci, and group A Streptococcus.
†
Other gram-positive organisms include Bacillus, Corynebacterium, Staphylococcus aureus.
§
Other gram-negative organisms include Klebsiella, Pseudomonas, Acinetobacter, Proteus, Morganella,
and Fusobacterium.
Adapted from Stoll et al. Pediatr Infect Dis J. 2005;24:635–639.
Table 3. Risk Factors for Early-onset
GBS Sepsis in the Absence of IAP
Risk Factor
Odds Ratio (95%
Confidence Interval)
Maternal GBS colonization 204 (100 to 419)
Birthweight <1,000 g 24.8 (12.2 to 50.2)
Birthweight <2,500 g 7.37 (4.48 to 12.1)
Rupture of membranes
>18 h
7.28 (4.42 to 12.0)
Chorioamnionitis 6.42 (2.32 to 17.8)
Intrapartum temperature
>99.5°F (37.5°C)
4.05 (2.17 to 7.56)
GBSϭgroup B Streptococcus, IAPϭintrapartum antibiotic prophylaxis.
Adapted from Benitz et al. Pediatrics. 1999;103:e77.
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5. multiple gestation now is not considered an independent
risk factor for EOS. (10) GBS bacteriuria during preg-
nancy is associated with heavy colonization of the recto-
vaginal tract and is considered a significant risk factor for
EOS. Black race is associated with higher rates of GBS
EOS, although it is not entirely clear whether this simply
reflects the higher rate of GBS colonization in this pop-
ulation. The most recent CDC surveillance data demon-
strate a fourfold increased incidence of neonatal GBS
EOS among black infants compared with white infants.
(1)
IAP for the Prevention of Early-onset
GBS infection
After recognizing that maternal colonization with GBS
was the greatest risk factor for neonatal GBS disease,
multiple trials demonstrated that the use of intrapartum
penicillin or ampicillin significantly reduced the rate of
neonatal colonization with GBS and the incidence of
early-onset GBS disease. The ability to prevent neonatal
GBS colonization and neonatal EOS was demonstrated
most dramatically in a trial of only 160 women in 1986.
(11) IAP for the prevention of GBS EOS can be admin-
istered to pregnant women during labor based on specific
clinical risk factors for early-onset GBS infection or the
results of antepartum screening of pregnant women for
GBS colonization. In 1996, the CDC published consen-
sus guidelines for the prevention of neonatal GBS disease
that endorsed the use of either a risk factor-based or
screening-based approach. (10) The CDC later con-
ducted a large retrospective cohort study of more than
600,000 births that demonstrated the superiority of the
screening-based approach for the prevention of neonatal
GBS disease. (12) Based on these results, the CDC issued
revised guidelines for the prevention of early-onset GBS
disease in 2002, recommending universal screening of
pregnant women for GBS by rectovaginal culture at
35 to 37 weeks’ gestation and management of IAP based
on screening results. (13) The revised guidelines can be
accessed at http://www.cdc.gov/mmwr/preview/
mmwrhtml/rr5111a1.htm or in PDF form at http://
www.cdc.gov/mmwr/PDF/rr/rr5111.pdf.
The CDC guideline includes specific recommenda-
tions for pregnant women who have documented GBS
bacteriuria or who previously delivered infants who had
GBS disease and for the use of IAP in women experienc-
ing threatened preterm labor. The revised guidelines also
address concerns over the documented emergence of
GBS resistance to erythromycin and clindamycin, antibi-
otics frequently used for IAP in women allergic to peni-
cillin. The CDC continues to recommend penicillin or
ampicillin for IAP. In those who have penicillin allergy,
testing of GBS screening isolates for antibiotic suscepti-
bility is recommended to guide the choice of antibiotic
(erythromycin, clindamycin, cefazolin, or vancomycin)
for IAP. “Adequate IAP” is defined as the administration
of one of the endorsed antibiotics 4 or more hours prior
to delivery. The revised CDC guideline also includes a
recommended algorithm for the evaluation of infants
born to mothers exposed to IAP.
Current Status of GBS EOS
CDC active surveillance data for the United States from
1999 to 2005 demonstrate that the incidence of GBS
EOS has fallen to 0.34 cases per 1,000 live births in
2003 to 2005 (compared with 1.7 cases per 1,000 live
births in 1993). (1) We recently evaluated the reasons for
persistent GBS EOS despite the use of a screening-based
approach to IAP at the BWH. (14)(15) We found that
most GBS EOS in term infants now occurs in infants
born to women who have negative antepartum screening
results for GBS colonization. Many of the mothers in this
study had other intrapartum risk factors for sepsis, un-
derscoring the importance of continued evaluation of
infants at risk for EOS in the era of GBS prophylaxis.
There is a low incidence (approximately 4%) of noncon-
cordance between results of maternal GBS screening
performed at 35 to 37 weeks’ gestation and repeat
screening on presentation for delivery at term, (16)
which may account for many cases of persistent GBS
EOS.
Bacterial culture remains the CDC-recommended
standard for detection of maternal GBS colonization. In
2002, the United States Food and Drug Administration
approved the first polymerase chain reaction (PCR)-
based rapid diagnostic test for use in detection of mater-
nal GBS colonization. The test can be completed in
1 hour and potentially allows for screening of pregnant
women on presentation for delivery. (17) Although this
type of testing could address the risk of antenatal false-
negative GBS screens, the costs and technicalities of
providing continuous support for a real-time PCR-based
diagnostic are considerable, and most obstetric services
continue to rely on antenatal screening culture alone.
EOS Caused by E coli
E coli is the second most common organism isolated in
EOS in all neonates and the single most common EOS
organism in VLBW infants. (3)(6) E coli are facultative
anaerobic gram-negative rods found universally in the
human intestinal tract and commonly in the human
vagina and urinary tract. There are hundreds of different
infectious disease sepsis
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6. antigenic types of E coli, but EOS E coli infections,
particularly those complicated by meningitis, are primar-
ily due to strains that have the K1-type polysaccharide
capsule. With the implementation of IAP against GBS,
an increasing proportion of EOS cases are caused by
gram-negative organisms. (4) Whether GBS IAP policies
are contributing to an absolute increase in the incidence
of EOS caused by gram-negative organisms, particularly
ampicillin-resistant gram-negative organisms, is contro-
versial.
In 2003, the CDC published a review of 23 reports of
EOS in the era of GBS prophylaxis, (4) which concluded
that there is no evidence of an increase in non-GBS EOS
among term infants. A case-control study of 132 cases of
neonatal EOS caused by E coli occurring from 1997 to
2001 recently published by the CDC concluded that
exposure to intrapartum antibiotic therapy did not in-
crease the odds of invasive early-onset E coli infection.
(18) In fact, this study demonstrated a protective effect
of intrapartum antibiotic exposure on the risk of E coli
EOS among term infants. However, worrisome increases
in non-GBS EOS and ampicillin-resistant EOS in VLBW
infants have been reported by single centers (19) and by
the NICHD Neonatal Research Network. (20) The mul-
ticenter NICHD Network documented an increase in E
coli EOS in VLBW infants from 3.2 cases per 1,000 live
births in 1991 to 1993 to 7.0 cases per 1,000 live births
in 2002 to 2003.
Trends in the microbiology of EOS likely vary to some
extent by institution and may be influenced by local
obstetric practices as well as by local variation in indige-
nous bacterial flora. To address this important issue, the
CDC Active Bacterial Core Surveillance Program and the
NICHD Neonatal Research Network are conducting
active surveillance for early-onset neonatal sepsis from
2007 to 2009 that will include data on intrapartum
antibiotic exposure and collection of specific infecting
bacterial isolates for microbiologic study. (21) Informa-
tion from studies of this type may help guide clinical
decisions regarding empiric antibiotic choice for EOS,
particularly in VLBW infants. Currently, when there is
strong clinical suspicion for sepsis in a critically ill infant,
the possibility of ampicillin-resistant gram-negative in-
fection suggests the consideration of empiric use of a
third-generation cephalosporin such as cefotaxime or
ceftazidime.
Other Organisms Responsible for EOS
In addition to GBS and E coli, a number of other patho-
gens that cause EOS in the United States deserve special
note. Listeria monocytogenes are gram-positive, beta-
hemolytic, motile bacteria that most commonly infect
humans via the ingestion of contaminated food. An
association with prepared foods held at moderate tem-
perature (particularly cheeses and deli meats) has been
documented, occasionally in epidemic outbreaks. These
bacteria do not cause significant disease in immunocom-
petent adults but can cause severe illness in the immuno-
compromised (ie, renal transplant patients), in pregnant
women and their fetuses, and in newborns. The true
incidence of listeriosis in pregnancy is difficult to deter-
mine because many cases are undiagnosed when they
result in spontaneous abortion of the previable fetus.
Obligate anaerobic bacteria (primarily the encapsulated
enteric organism Bacteroides fragilis) can cause neonatal
EOS and justify the use of both aerobic and anaerobic
blood culture bottles in the evaluation of EOS. Although
both methicillin-sensitive and methicillin-resistant S au-
reus (MRSA) cause a large proportion of hospital-
acquired infection in VLBW infants and represent an
increasing issue in community-acquired pediatric infec-
tions, they remain a rare cause of neonatal EOS. A recent
study of 5,732 pregnant women documented a 3.5%
incidence of MRSA in GBS rectovaginal screening cul-
tures but found no cases of MRSA neonatal EOS in
delivered infants. (22) Finally, fungal organisms (primar-
ily Candida sp) rarely cause neonatal EOS. Fungal EOS
is found largely in preterm and VLBW infants and in our
center is associated with very prolonged antibiotic (Ͼ24
h) exposure of pregnant mothers prior to delivery.
Clinical Risk Factors for EOS
Maternal and infant characteristics associated with the
development of EOS have been studied most rigorously
with respect to GBS EOS, but much of these data were
obtained prior to the implementation of IAP for GBS
prevention. Perhaps the most challenging clinical issue in
the era of GBS prophylaxis is the identification and
evaluation of the initially asymptomatic term and late
preterm infant at risk for EOS. Escobar and associates
(23) studied a cohort of more than 18,000 infants born
in 1995 to 1996, cared for in a single health-care plan,
whose birthweights were at least 2,000 g, and who had
no major anomalies. Of these, 2,785 infants were evalu-
ated for EOS with a complete blood count and blood
culture. Multivariate analyses of predictors of EOS ac-
counted for intrapartum antibiotic exposure and mod-
eled maternal chorioamnionitis either as a clinical obstet-
ric diagnosis or as an entity defined by prolonged rupture
of membranes and maternal fever. Results of the latter
model are shown in Table 4, but the overall findings were
the same in each model: maternal intrapartum fever, the
infectious disease sepsis
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7. clinical diagnosis of chorioamnionitis, low absolute neu-
trophil count, and the presence of meconium-stained
amniotic fluid each were associated with increased risk of
EOS, with some modification of these factors in the
presence of maternal intrapartum antibiotic exposure.
Although this study aids in our understanding the issues
of overall EOS risk in the era of GBS prophylaxis, it also
underscores the challenge of evaluating the initially
asymptomatic infant. Only 1% of the initially asymptom-
atic infants in this study had EOS, and asymptomatic
status predicted against infection. Yet, this incidence is
10-fold higher than the population risk of 1 to 2 cases per
1,000 live births, pointing out the importance of the
clinical factors that prompted the evaluation for infection
and confirming the concept that asymptomatic status
alone cannot rule out infection.
Algorithm for the Evaluation of
Asymptomatic Infants at Risk for EOS
The CDC 2002 guidelines for the use of IAP to prevent
early-onset GBS disease address the evaluation of infants
at risk for GBS-specific EOS. Other microbiologic causes
of EOS also must be considered in evaluating the asymp-
tomatic infant at risk for infection. Many centers develop
protocols to standardize the decision to evaluate an
asymptomatic infant for EOS. We use a protocol for
evaluation of the asymptomatic infant born at 35 or more
weeks’ gestation who is at risk for EOS (Figure). This
protocol takes into account the 2002 CDC guideline for
GBS prophylaxis as well as the existing literature on the
risk of overall EOS. In addition, it accounts for center-
specific factors (including the primary role of pediatric
resident housestaff in conducting
EOS evaluations at our center and
the use of epidural analgesia in most
deliveries). A total white blood cell
count less than 5.0ϫ103
/mcL
(5.0ϫ109
/L) or an immature to
total neutrophil ratio greater than
0.2 is used to guide treatment de-
cisions in the evaluation of the
well-appearing infant at risk for
sepsis. A single white blood cell
determination is used in most cases
to avoid multiple blood collections
from otherwise asymptomatic in-
fants. This particular algorithm may
not be ideal for all centers and only
is included as a model protocol.
A quality improvement study con-
ducted at our institution compared
the rate of compliance with CDC recommendations
for the evaluation of infants at risk for early-onset GBS
disease between hospitals within our health-care system
that did or did not have a mandated protocol and found
significantly greater compliance in the hospitals that used
a specific protocol.
Current Clinical Challenges in EOS
EOS remains an infrequent but potentially devastating
clinical issue for term and preterm infants. The wide-
spread implementation of IAP for the prevention of
GBS early-onset disease has resulted in an overall de-
crease in neonatal EOS in the United States. There
remain, however, a number of research questions that
need to be addressed to optimize neonatal care further
with respect to EOS. Considerable clinical time and
economic resources are expended in the identification
and evaluation of infants at risk for EOS. A multicenter
reassessment of the clinical risk factors for EOS in the
setting of proper implementation of a screening-based
program for IAP should be performed. Such a study may
allow clinicians to identify more accurately the initially
asymptomatic infant who needs to be evaluated for in-
fection in the era of GBS prophylaxis. The utility of
real-time PCR-based GBS diagnostics, used either as a
substitute for third trimester culture-based GBS screen-
ing or as an addition to culture-based screening, needs to
be assessed on a national basis to determine if this test can
lower the national incidence of early-onset GBS disease
further. Finally, the CDC has endorsed the need for
continued surveillance to assess the impact of GBS pro-
phylaxis practices on the microbiology of EOS, particu-
Table 4. Risk Factors for All Causes of Early-onset
Sepsis in Infants Weighing Less than 2,000 g
At Birth in the Era of Intrapartum Antibiotic
Prophylaxis
Multivariate Odds Ratio (95% Confidence
Interval)
Predictor
No Intrapartum
Antibiotics
(n)865,1؍
Intrapartum
Antibiotics
(n)712,1؍
Temperature >101.5°F (38.6°C) 5.78 (1.57 to 21.29) 3.50 (1.30 to 9.42)
Rupture of membranes >12 h 2.05 (1.06 to 3.96) Not significant
Low absolute neutrophil count
for age
2.82 (1.50 to 5.34) 3.60 (1.45 to 8.96)
Infant asymptomatic 0.27 (0.11 to 0.65) 0.42 (0.16 to 1.11)
Meconium in amniotic fluid 2.24 (1.19 to 4.22) Not significant
Adapted from Escobar et al. Pediatrics. 2000;106:256–263.
infectious disease sepsis
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8. larly among VLBW infants. Research into individual
center obstetric practices as well as national surveillance
may help identify the risks that may be associated with
IAP to allow neonates to continue to benefit from this
important advance in the prevention of EOS.
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Figure. Guidelines for the management of asymptomatic infants born at 35 or more weeks’ gestation who have risk factors for
early-onset sepsis. CBC؍complete blood count, Csxn؍cesarean section delivery, FHR؍fetal heart rate, GBS؍group B Streptococcus,
IAP؍intrapartum antibiotic prophylaxis, I:T؍immature to total, PMN؍polymorphonuclear lymphocytes, PTD؍prior to delivery,
ROM؍rupture of membranes, WBC-white blood cell.
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10. NeoReviews Quiz
5. Widespread implementation of intrapartum antibiotic prophylaxis has altered the epidemiology of early-
onset sepsis (occurring at less than 72 hours after birth) in the newborn. The incidence of group B
Streptococcus (GBS) early-onset sepsis has decreased; the incidence of non-GBS early-onset sepsis is
unchanged or decreasing. Of the following, the national incidence of GBS early-onset sepsis, as estimated
in 2003 through 2005, is closest to:
A. 0.03 per 1,000 live births.
B. 0.30 per 1,000 live births.
C. 0.60 per 1,000 live births.
D. 0.90 per 1,000 live births.
E. 0.20 per 1,000 live births.
6. The spectrum of microorganisms causing early-onset sepsis in the era of intrapartum antibiotic prophylaxis
is different between term neonates (>2,000 g birthweight) and very low-birthweight neonates (<1,500 g
birthweight). Of the following, the most common microorganism attributable to early-onset sepsis in term
neonates, as reported by the Centers for Disease Control and Prevention, is:
A. Coagulase-negative Staphylococcus.
B. Escherichia coli
C. Group B Streptococcus.
D. Haemophilus influenzae.
E. Listeria monocytogenes.
7. The spectrum of microorganisms causing early-onset sepsis in the era of intrapartum antibiotic prophylaxis
is different between term neonates (>2,000 g birthweight) and very low-birthweight (VLBW) neonates
(<1,500 g birthweight). Of the following, the most common microorganism attributable to early-onset
sepsis in VLBW neonates, as reported by the National Institute of Health and Human Development Neonatal
Research Network, is:
A. Coagulase-negative Staphylococcus.
B. Escherichia coli.
C. Group B Streptococcus.
D. Haemophilus influenzae.
E. Listeria monocytogenes.
8. Most cases of early-onset sepsis attributable to GBS in the United States currently are caused by GBS
serotypes Ia, Ib, II, III, and V. Intrapartum antibiotic prophylaxis for prevention of GBS sepsis was advocated
following several studies examining the maternal and neonatal risk factors for early-onset GBS sepsis. Of
the following, the clinical risk factor most predictive of neonatal early-onset GBS sepsis in the absence of
intrapartum antibiotic prophylaxis is:
A. Chorioamnionitis.
B. Extremely low birthweight (<1,000 g).
C. Intrapartum fever (temperature >99.5°F [37.5°C]).
D. Maternal GBS colonization.
E. Prolonged rupture of membranes (>18 hours).
infectious disease sepsis
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11. DOI: 10.1542/neo.9-12-e571
2008;9;e571-e579NeoReviews
Karen M. Puopolo
Epidemiology of Neonatal Early-onset Sepsis
& Services
Updated Information
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