Vaccination in adults - Slideset by Professor Paolo BonanniWAidid
The slideset by professor Paolo Bonanni on vaccination in adults makes an overview on influenza, streptococcus pneumoniae, diphtheria, tetanus, pertussis, Human Papilloma Virus (HPV), measles, mumps, rubella, varicella and tick borne encephalitis. Where we were and where we are.
Hepatitis A is an under rated infectious disease in children , with high morbidity and a major cause of fulminant hepatitis in children.There has been a longstanding debate between the LIVE VACCINE FOR HEPATITIS A AND THE KILLED INACTIVATED VACCINE FOR HEPATITIS A. Recent CDC guidelines and INDIAN ACADEMY OF PEDIATRICS GUIDELINES and recent references were studied before making these slides. Hope you find these useful.
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
Vaccination in adults - Slideset by Professor Paolo BonanniWAidid
The slideset by professor Paolo Bonanni on vaccination in adults makes an overview on influenza, streptococcus pneumoniae, diphtheria, tetanus, pertussis, Human Papilloma Virus (HPV), measles, mumps, rubella, varicella and tick borne encephalitis. Where we were and where we are.
Hepatitis A is an under rated infectious disease in children , with high morbidity and a major cause of fulminant hepatitis in children.There has been a longstanding debate between the LIVE VACCINE FOR HEPATITIS A AND THE KILLED INACTIVATED VACCINE FOR HEPATITIS A. Recent CDC guidelines and INDIAN ACADEMY OF PEDIATRICS GUIDELINES and recent references were studied before making these slides. Hope you find these useful.
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
ROTAVIRUS VACCINES IN INDIA .WHICH ONE WILL YOU CHOOSE AND WHY?DR SHAILESH MEHTA
Many brands of Rotavirus vaccine are available in India. However we need to have full evidence based decision making before we choose one rotavirus vaccine over another. This slideshow focuses on the need to have Indian studies which are not there with some of the international brands. Regionwise variability of rotavirus vaccines have prompted ICMR and various other scientific bodies in India to have our own data on efficacy of rotaviral vaccines in Indian scenario. Diarrhoea is a major cause of under 5 mortality in children. After the use of rotavirus vaccines there is a huge reduction of financial burden on our healthcare sytems.
Childhood diarrhoea incidence and severity have decreased ever since rotavirus vaccine was made a part of national immunization schedule.
Comparative Studies of Knowledge and Perception of Parents on Home Management...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Top 10 practical questions about Flu Vaccine in India!Gaurav Gupta
What does a practising paediatrician want to to know about the Flu vaccination? Talk for Abbott Vaccines (Influvac Tetra) in Oct 2020 about common queries that doctors have about the flu vaccine in India, including how it may help in COVID-19?
At the four front of flu vaccination - Quadrivalent Flu Vaccination in India ...Gaurav Gupta
Is flu vaccination needed in India? Is there any benefits of Quadrivalent Flu vaccination over Trivalent Flu vaccination? Any safety & efficacy data about Vaxiflu 4 by Zydus Vaccines. All discussed in a Presentation in Panchkula, in September 2019
Role of vaccines and child health - Professor Shabir MadhiWAidid
"Role of vaccines in making the world a better place for children" - Slideset by professor Madhi (WAidid Board Member) presented at the 2015 World Congress of Nephrology, held in Cape Town from March 13-17 2015.
Find more on www.waidid.org
Combination vaccines against diarrheal diseasesMalabi M Venk.docxdrandy1
Combination vaccines against diarrheal diseases
Malabi M Venkatesan1,* and Lillian L Van de Verg2
1Bacterial Diseases Branch; Walter Reed Army Institute of Research; Silver Spring, MD USA; 2Enteric Vaccine Initiative; Vaccine Development Global Program;
PATH; Washington, DC USA
Keywords: combination, diarrhea, ETEC, Shigella, vaccines
Diarrheal diseases remain a leading cause of global
childhood mortality and morbidity. Several recent
epidemiological studies highlight the rate of diarrheal
diseases in different parts of the world and draw attention to
the impact on childhood growth and survival. Despite the
well-documented global burden of diarrheal diseases,
currently there are no combination diarrheal vaccines, only
licensed vaccines for rotavirus and cholera, and Salmonella
typhi-based vaccines for typhoid fever. The recognition of the
impact of diarrheal episodes on infant growth, as seen in
resource-poor countries, has spurred action from
governmental and non-governmental agencies to accelerate
research toward affordable and effective vaccines against
diarrheal diseases. Both travelers and children in endemic
countries will benefit from a combination diarrheal vaccine,
but it can be argued that the greater proportion of any
positive impact will be on the public health status of the
latter. The history of combination pediatric vaccines indicate
that monovalent or single disease vaccines are typically
licensed first prior to formulation in a combination vaccine,
and that the combinations themselves undergo periodic
revision in response to need for improvement in safety or
potential for wider coverage of important pediatric
pathogens. Nevertheless combination pediatric vaccines have
proven to be an effective tool in limiting or eradicating
communicable childhood diseases worldwide. The landscape
of diarrheal vaccine candidates indicates that there now
several in active development that offer options for potential
testing of combinations to combat those bacterial and viral
pathogens responsible for the heaviest disease burden—
rotavirus, ETEC, Shigella, Campylobacter, V. cholera and
Salmonella.
Introduction
Several recent large scale studies of global diarrheal disease
burden and epidemiology, renewed recognition of multiple
diarrhea episodes as a serious impediment to the health and
development of children in resource-poor countries, an
upsurge in the investment by charitable foundations and gov-
ernmental entities in combatting global infectious diseases
and the emergence of new concepts in vaccination strategies
collectively point to opportunities to develop new vaccines
against very old diseases. In this paper, we first review up-to-
date information on diarrheal disease burden as a rationale
for the pursuit of vaccine development. The history of the
development and challenges of combination pediatric vaccines
are presented as a model for combination diarrheal vaccines
for children in endemic parts of the world as well as for trav.
Combination vaccines against diarrheal diseasesMalabi M Venk.docxcargillfilberto
Combination vaccines against diarrheal diseases
Malabi M Venkatesan1,* and Lillian L Van de Verg2
1Bacterial Diseases Branch; Walter Reed Army Institute of Research; Silver Spring, MD USA; 2Enteric Vaccine Initiative; Vaccine Development Global Program;
PATH; Washington, DC USA
Keywords: combination, diarrhea, ETEC, Shigella, vaccines
Diarrheal diseases remain a leading cause of global
childhood mortality and morbidity. Several recent
epidemiological studies highlight the rate of diarrheal
diseases in different parts of the world and draw attention to
the impact on childhood growth and survival. Despite the
well-documented global burden of diarrheal diseases,
currently there are no combination diarrheal vaccines, only
licensed vaccines for rotavirus and cholera, and Salmonella
typhi-based vaccines for typhoid fever. The recognition of the
impact of diarrheal episodes on infant growth, as seen in
resource-poor countries, has spurred action from
governmental and non-governmental agencies to accelerate
research toward affordable and effective vaccines against
diarrheal diseases. Both travelers and children in endemic
countries will benefit from a combination diarrheal vaccine,
but it can be argued that the greater proportion of any
positive impact will be on the public health status of the
latter. The history of combination pediatric vaccines indicate
that monovalent or single disease vaccines are typically
licensed first prior to formulation in a combination vaccine,
and that the combinations themselves undergo periodic
revision in response to need for improvement in safety or
potential for wider coverage of important pediatric
pathogens. Nevertheless combination pediatric vaccines have
proven to be an effective tool in limiting or eradicating
communicable childhood diseases worldwide. The landscape
of diarrheal vaccine candidates indicates that there now
several in active development that offer options for potential
testing of combinations to combat those bacterial and viral
pathogens responsible for the heaviest disease burden—
rotavirus, ETEC, Shigella, Campylobacter, V. cholera and
Salmonella.
Introduction
Several recent large scale studies of global diarrheal disease
burden and epidemiology, renewed recognition of multiple
diarrhea episodes as a serious impediment to the health and
development of children in resource-poor countries, an
upsurge in the investment by charitable foundations and gov-
ernmental entities in combatting global infectious diseases
and the emergence of new concepts in vaccination strategies
collectively point to opportunities to develop new vaccines
against very old diseases. In this paper, we first review up-to-
date information on diarrheal disease burden as a rationale
for the pursuit of vaccine development. The history of the
development and challenges of combination pediatric vaccines
are presented as a model for combination diarrheal vaccines
for children in endemic parts of the world as well as for trav.
ROTAVIRUS VACCINES IN INDIA .WHICH ONE WILL YOU CHOOSE AND WHY?DR SHAILESH MEHTA
Many brands of Rotavirus vaccine are available in India. However we need to have full evidence based decision making before we choose one rotavirus vaccine over another. This slideshow focuses on the need to have Indian studies which are not there with some of the international brands. Regionwise variability of rotavirus vaccines have prompted ICMR and various other scientific bodies in India to have our own data on efficacy of rotaviral vaccines in Indian scenario. Diarrhoea is a major cause of under 5 mortality in children. After the use of rotavirus vaccines there is a huge reduction of financial burden on our healthcare sytems.
Childhood diarrhoea incidence and severity have decreased ever since rotavirus vaccine was made a part of national immunization schedule.
Comparative Studies of Knowledge and Perception of Parents on Home Management...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Top 10 practical questions about Flu Vaccine in India!Gaurav Gupta
What does a practising paediatrician want to to know about the Flu vaccination? Talk for Abbott Vaccines (Influvac Tetra) in Oct 2020 about common queries that doctors have about the flu vaccine in India, including how it may help in COVID-19?
At the four front of flu vaccination - Quadrivalent Flu Vaccination in India ...Gaurav Gupta
Is flu vaccination needed in India? Is there any benefits of Quadrivalent Flu vaccination over Trivalent Flu vaccination? Any safety & efficacy data about Vaxiflu 4 by Zydus Vaccines. All discussed in a Presentation in Panchkula, in September 2019
Role of vaccines and child health - Professor Shabir MadhiWAidid
"Role of vaccines in making the world a better place for children" - Slideset by professor Madhi (WAidid Board Member) presented at the 2015 World Congress of Nephrology, held in Cape Town from March 13-17 2015.
Find more on www.waidid.org
Combination vaccines against diarrheal diseasesMalabi M Venk.docxdrandy1
Combination vaccines against diarrheal diseases
Malabi M Venkatesan1,* and Lillian L Van de Verg2
1Bacterial Diseases Branch; Walter Reed Army Institute of Research; Silver Spring, MD USA; 2Enteric Vaccine Initiative; Vaccine Development Global Program;
PATH; Washington, DC USA
Keywords: combination, diarrhea, ETEC, Shigella, vaccines
Diarrheal diseases remain a leading cause of global
childhood mortality and morbidity. Several recent
epidemiological studies highlight the rate of diarrheal
diseases in different parts of the world and draw attention to
the impact on childhood growth and survival. Despite the
well-documented global burden of diarrheal diseases,
currently there are no combination diarrheal vaccines, only
licensed vaccines for rotavirus and cholera, and Salmonella
typhi-based vaccines for typhoid fever. The recognition of the
impact of diarrheal episodes on infant growth, as seen in
resource-poor countries, has spurred action from
governmental and non-governmental agencies to accelerate
research toward affordable and effective vaccines against
diarrheal diseases. Both travelers and children in endemic
countries will benefit from a combination diarrheal vaccine,
but it can be argued that the greater proportion of any
positive impact will be on the public health status of the
latter. The history of combination pediatric vaccines indicate
that monovalent or single disease vaccines are typically
licensed first prior to formulation in a combination vaccine,
and that the combinations themselves undergo periodic
revision in response to need for improvement in safety or
potential for wider coverage of important pediatric
pathogens. Nevertheless combination pediatric vaccines have
proven to be an effective tool in limiting or eradicating
communicable childhood diseases worldwide. The landscape
of diarrheal vaccine candidates indicates that there now
several in active development that offer options for potential
testing of combinations to combat those bacterial and viral
pathogens responsible for the heaviest disease burden—
rotavirus, ETEC, Shigella, Campylobacter, V. cholera and
Salmonella.
Introduction
Several recent large scale studies of global diarrheal disease
burden and epidemiology, renewed recognition of multiple
diarrhea episodes as a serious impediment to the health and
development of children in resource-poor countries, an
upsurge in the investment by charitable foundations and gov-
ernmental entities in combatting global infectious diseases
and the emergence of new concepts in vaccination strategies
collectively point to opportunities to develop new vaccines
against very old diseases. In this paper, we first review up-to-
date information on diarrheal disease burden as a rationale
for the pursuit of vaccine development. The history of the
development and challenges of combination pediatric vaccines
are presented as a model for combination diarrheal vaccines
for children in endemic parts of the world as well as for trav.
Combination vaccines against diarrheal diseasesMalabi M Venk.docxcargillfilberto
Combination vaccines against diarrheal diseases
Malabi M Venkatesan1,* and Lillian L Van de Verg2
1Bacterial Diseases Branch; Walter Reed Army Institute of Research; Silver Spring, MD USA; 2Enteric Vaccine Initiative; Vaccine Development Global Program;
PATH; Washington, DC USA
Keywords: combination, diarrhea, ETEC, Shigella, vaccines
Diarrheal diseases remain a leading cause of global
childhood mortality and morbidity. Several recent
epidemiological studies highlight the rate of diarrheal
diseases in different parts of the world and draw attention to
the impact on childhood growth and survival. Despite the
well-documented global burden of diarrheal diseases,
currently there are no combination diarrheal vaccines, only
licensed vaccines for rotavirus and cholera, and Salmonella
typhi-based vaccines for typhoid fever. The recognition of the
impact of diarrheal episodes on infant growth, as seen in
resource-poor countries, has spurred action from
governmental and non-governmental agencies to accelerate
research toward affordable and effective vaccines against
diarrheal diseases. Both travelers and children in endemic
countries will benefit from a combination diarrheal vaccine,
but it can be argued that the greater proportion of any
positive impact will be on the public health status of the
latter. The history of combination pediatric vaccines indicate
that monovalent or single disease vaccines are typically
licensed first prior to formulation in a combination vaccine,
and that the combinations themselves undergo periodic
revision in response to need for improvement in safety or
potential for wider coverage of important pediatric
pathogens. Nevertheless combination pediatric vaccines have
proven to be an effective tool in limiting or eradicating
communicable childhood diseases worldwide. The landscape
of diarrheal vaccine candidates indicates that there now
several in active development that offer options for potential
testing of combinations to combat those bacterial and viral
pathogens responsible for the heaviest disease burden—
rotavirus, ETEC, Shigella, Campylobacter, V. cholera and
Salmonella.
Introduction
Several recent large scale studies of global diarrheal disease
burden and epidemiology, renewed recognition of multiple
diarrhea episodes as a serious impediment to the health and
development of children in resource-poor countries, an
upsurge in the investment by charitable foundations and gov-
ernmental entities in combatting global infectious diseases
and the emergence of new concepts in vaccination strategies
collectively point to opportunities to develop new vaccines
against very old diseases. In this paper, we first review up-to-
date information on diarrheal disease burden as a rationale
for the pursuit of vaccine development. The history of the
development and challenges of combination pediatric vaccines
are presented as a model for combination diarrheal vaccines
for children in endemic parts of the world as well as for trav.
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
A prospective observational study was conducted in the Neonatal Unit of Indraprastha Apollo Hospital over a period of 10 months. A total of 86 high risk newborns were included to study the mortality and morbidity pattern. Majority of these (68%) were outborn male babies. Sixty five percent were preterm and 36% low birth weight. Overall survival was 77.2% and was better in inborn babies. Survival was directly proportional to gestation and birth weight. Systemic infection was associated with higher mortality and morbidity. Klebsiella was the commonest organism cultured followed by Candida. Hyaline membrane disease was the commonest Respiratory morbidity. Sixty Seven pecent required ventilatory support and mortality was directly proportional to the duration of ventilation. Only six percent of the survivors had Neurodevelopmental delay at 6 months and 1 baby had hearing impairment requiring Cochlear implant. They continue to be on long term follow up.
A prospective observational study was conducted in the Neonatal Unit of Indraprastha Apollo Hospital over a period of 10 months. A total of 86 high-risk newborns were included to study the mortality and morbidity patterns. Majority of these (68%) were outborn male babies: 65% were pre-term and 36% were low birth weight. Overall survival was 77.2% and was better in inborn babies. Survival was directly proportional to gestation and birth weight. Systemic infection was associated with higher mortality and morbidity. Klebsiella was the commonest organism cultured followed by Candida. Hyaline membrane disease was the commonest respiratory morbidity. Sixty-seven percent required ventilatory support, and mortality was directly proportional to the duration of ventilation. Only 6% of the survivors had neurodevelopmental delay at 6 months and one baby had hearing impairment requiring cochlear implant. They continue to be on long-term follow-up.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Sepsis neonatal manejo antimicrobiano ideal
1. INFECTIOUS DISEASE (J GLAUSER, SECTION EDITOR)
Neonatal Sepsis
Muhammed Ershad1
& Ahmed Mostafa1
& Maricel Dela Cruz1
& David Vearrier1
Published online: 19 June 2019
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
Purpose of Review Neonatal sepsis is a diagnosis made in infants less than 28 days of life and consists of a clinical syndrome that
may include systemic signs of infection, circulatory shock, and multisystem organ failure.
Recent Findings Commonly involved bacteria include Staphylococcus aureus and Escherichia coli. Risk factors include central
venous catheter use and prolonged hospitalization. Neonates are at significant risk of delayed recognition of sepsis until more
ominous clinical findings and vital sign abnormalities develop. Blood culture remains the gold standard for diagnosis.
Summary Neonatal sepsis remains an important diagnosis requiring a high index of suspicion. Immediate treatment with
antibiotics is imperative.
Keywords neonatal sepsis . neonatal fever . newborn sepsis . newborn fever
Abbreviations
RF Risk factor
AAP American Academy of Pediatrics
PROM Prolonged rupture of membranes
GBS Group B streptococcus
abx Antibiotics
h Hour
Introduction
Neonatal sepsis is a diagnosis made in infants less than 28
days of life and consists of a clinical syndrome that may in-
clude systemic signs of infection, circulatory shock, and mul-
tisystem organ failure. Neonatal sepsis may be divided into
two types: early-onset neonatal sepsis (EONS) and late-onset
neonatal sepsis (LONS). EONS is typically described as in-
fection and sepsis occurring within the first 24 hours to first
week of life [1–3]. LONS has been labeled as after 24 hours or
after the first week of life, up to 28 days or 1 month [4–6]. The
literature varies in the definition of EONS and LONS, but
most categorize EONS as within the first 72 hours of life
and LONS as after this time period up to 28 days [7–10].
Some have proposed the need to create a unified definition
worldwide to further develop accuracy in the diagnosis and
treatment of EONS and LONS [11, 12•].
Classifications of neonates can be separated even further
depending on age and weight. A newborn is an infant within
the first 24 hours of life, while a neonate is up to 28 days old.
Preterm infants are those born at a gestational age less than 37
weeks, and term infants are those born at or after 37 weeks of
gestation. Low birth weight (LBW) is considered less than
2,500 grams and very low birth weight (VLBW) is less than
1,500 g. Extremely low birth weight (ELBW) is used to de-
scribe neonates less than 1,000 g. These designations become
significant when discussing the etiology of and risk factors for
neonatal sepsis. Neonatal sepsis can also be defined as clini-
cally diagnosed or confirmed by positive culture in a typically
sterile bodily fluid. The gold standard for the diagnosis of
neonatal sepsis is a positive culture in the blood, urine, cere-
brospinal fluid, peritoneal fluid, or any other sterile tissues
[13, 14].
Methods
We performed a search of the MEDLINE database for the
keywords and titles, “neonatal sepsis,” “neonatal fever,”
“newborn sepsis,” and “newborn fever,” covering the period
January 1, 2018 to December 31, 2018, which resulted in a
This article is part of the Topical Collection on Infectious Disease
* David Vearrier
djv27@drexel.edu
1
College of Medicine, Drexel University, 245 N 15th St, MS #1011,
Philadelphia, PA 19102, USA
Current Emergency and Hospital Medicine Reports (2019) 7:83–90
https://doi.org/10.1007/s40138-019-00188-z
2. total of 1,107 citations. Limiting the search to articles pub-
lished in the English language and including only human
studies yielded a total of 1,055 citations. These 1,055 articles
were manually reviewed for relevance and there were a total
of 64 citations. The remaining 1,003 were not cited as they did
not contain relevant information, contained outdated informa-
tion, or were superseded by more recent articles.
Epidemiology
Worldwide, neonatal sepsis occurs in about 1 to 50 out of
1,000 live births and accounts for 3 to 30% of infant and child
deaths annually [15, 16]. In a prospective study performed
between 1997 and 1999 at several neonatal centers in South
Korea, the incidence rate of neonatal sepsis was 6 per 1,000
live births in those with positive cultures and 30 per 1,000 live
births in clinically diagnosed neonatal sepsis [7]. Fatality rates
in this study were 2.2% in culture-confirmed neonatal sepsis
and 4.7% in clinically diagnosed neonatal sepsis [7]. An anal-
ysis performed in Taiwan from 2001 to 2006 found an inci-
dence rate of 4 out of 1,000 live births in all those diagnosed
with neonatal sepsis either clinically or by positive culture [8].
A retrospective study from the Netherlands showed a de-
crease in the incidence of EONS from 4% between 1978 to
1982 to 1.2% from 2003 to 2006 [17]. The incidence of LONS
in this study increased from 7.1% between 1978 to 1982 to
13.9% from 2003 to 2006 [17]. A review from the United
States (US) in 2012 reported that EONS occurs in 1.5 to 2%
of VLBW infants and LONS in 21% of VLBW infants [18]. In
an epidemiological study of culture positive diagnoses of neo-
natal sepsis in Switzerland from 2011 to 2015, the national
incidence was 1.43 out of 1,000 live births with a mortality
rate of up to 18% [19]. A systematic review that investigated
the global burden of neonatal sepsis from 1979 to 2016
showed an annual incidence of three million cases of neonatal
sepsis worldwide with a mortality rate of 19% [20].
Etiology
The organisms and pathogens that are most associated with
neonatal sepsis differ depending upon country involved.
Pathogens range from gram positive and negative bacteria to
viruses and fungi, with bacteria being the most frequently
identified. The most commonly implicated bacteria include
Staphylococcus aureus, coagulase negative staphylococci
(CONS), Streptococcus pneumoniae, Streptococcus
pyogenes, Escherichia coli, Klebsiella pneumoniae,
Pseudomonas aeruginosa, Salmonella typhi, and Group B
streptococcus (GBS) [21]. Viruses include echovirus, entero-
virus, parechovirus, coxsackie virus, adenovirus,
parainfluenza virus, rhinovirus, herpes simplex virus,
respiratory syncytial virus, and coronavirus [21]. Candida
albicans and other Candida species are the most common
fungi associated with neonatal sepsis [22].
In the 1990s, the American Academy of Pediatrics (AAP)
began to recommend the use of intrapartum antibiotic prophy-
laxis (IAP) to prevent perinatal GBS, and in 2002, the AAP
and the American College of Obstetricians and Gynecologists
instituted guidelines on the universal screening by culture of
all pregnant women from 35- to 37-week gestation. Due to the
widespread use of prophylactic antibiotics for neonates, par-
ticularly intrapartum antibiotic use in mothers with positive
cultures for GBS, the incidence of GBS-associated neonatal
sepsis has declined significantly, a decrease of 70% in the US
[8, 23]. During the same period, other countries such as
Canada and Taiwan have recommended the universal use of
IAP and have seen a decline in the incidence of neonatal sepsis
secondary to GBS infection as well [1, 24]. In such countries
where IAP is utilized, the most common causative agents of
neonatal sepsis are Escherichia coli and gram-positive organ-
isms [1, 24].
Risk Factors
In EONS, which is typically associated with vertical transmis-
sion of pathogens from mother to child, the most common
pathogens are GBS, Escherichia coli, CONS, Haemophilus
influenzae, and Listeria monocytogenes [3, 5, 25, 26]. In
LONS, which is most commonly associated with iatrogenic
or nosocomial infections, the most common pathogens are
CONS, followed by Staphylococcus aureus and Escherichia
coli [3, 17, 19, 24]. Risk factors include central venous cath-
eter use and other invasive medical devices as well as
prolonged hospitalization [27]. Other risk factors include pre-
term rupture of membranes, amnionitis, meconium aspiration,
LBW, VLBW, ELBW, preterm birth, greater than three vagi-
nal examinations during labor, fever in the mother during
labor, or any other infection in the mother during labor [14,
16, 28]. In full-term infants, males have a greater incidence of
sepsis compared to female infants, an association not found in
preterm infants [21]. A study performed in the US found sig-
nificant disparity and increased incidence of mortality second-
ary to neonatal sepsis among children from low household
income backgrounds versus those from affluent households
[OR 1.19, 95% confidence interval (1.05, 1.35)] [29••].
Clinical Findings
Considering the relatively subtle findings seen during the clin-
ical assessment, neonates are at significant risk of delayed
recognition of sepsis until more ominous clinical findings
and vital sign abnormalities develop. In the early onset type,
84 Curr Emerg Hosp Med Rep (2019) 7:83–90
3. they may have a history of fetal distress including fetal tachy-
cardia in the peripartum period. Soon after delivery, there may
be other clinical clues such as meconium-stained amniotic
fluid and low Apgar scores on initial neonatal assessment.
The caretaker may give a history of feeding intolerance, irri-
tability, excessive sleepiness, or “just not looking right.”
Vital sign derangements include both hypothermia and fe-
ver. Fever is more common in term babies whereas preterm
babies more often demonstrate hypothermia. There may be
tachycardia or bradycardia, signs of poor perfusion including
cool and pale extremities, and a rapid thready pulse.
Respiratory symptoms and signs are common in neonatal sep-
sis, including grunting, nasal flaring, use of accessory muscles
of respiration, cyanosis, and episodes of apnea. Neurological
symptoms and signs include lethargy, seizures, irregular res-
piration, high pitched cry, hypotonia, hypoactive deep tendon
reflexes, and abnormal primitive reflexes. Gastrointestinal
signs include decreased feeding, vomiting, diarrhea, jaundice,
abdominal distension, and hepatosplenomegaly. Skin findings
include petechiae, impetigo, cellulitis, and abscess.
Underlying metabolic acidosis secondary to poor perfusion
can manifest as tachypnea and respiratory distress in the ab-
sence of respiratory tract infection.
Diagnostic Testing
As the symptoms and signs of neonatal sepsis are often very
subtle and vague, it is imperative to perform diagnostic testing
in any neonate with significant risk factors and concerning signs
and symptoms. There are various multivariate predictive scor-
ing systems based on retrospective studies that may be used to
predict the need for antibiotics and extensive laboratory evalu-
ation of a neonate versus observation for concerning signs and
symptoms. One such example is the EONS calculator based on
a large retrospective population study performed in the US to
support clinicians in the decision to start antibiotics in neonates
suspected of having sepsis [30]. The newborn’s prior probabil-
ity of EONS obtained from maternal risk factors such as
chorioamnionitis and premature rupture of membranes is com-
bined with findings based on the clinical examination, creating
a scoring system that can determine the need for antibiotics and
level of monitoring required (Table 1). This scoring system has
been shown to reduce the proportion of newborns undergoing
extensive laboratory evaluation and administration of antibi-
otics without any adverse effects [31••]. The number needed
to treat (NNT) for the high-risk group requiring antibiotics de-
termined by this scoring system was still 118, highlighting the
challenges involved in coming up with better diagnostic tools in
picking up EONS at an early stage [32].
A complete blood count (CBC) should be performed to as-
sess for total and differential white blood cell count (WBC),
absolute and immature neutrophil count, and the ratio of
immature to total neutrophil count. Although an absolute leu-
kocytosis has low sensitivity for neonatal sepsis, they may aid
in clinical decision-making in cases where a low-to-moderate
clinical suspicion for sepsis is present. Interestingly, a low
WBC count, low absolute neutrophil count (ANC), and an
immature to total neutrophil ratio (I/T) of 0.2 or greater have
been shown to be highly predictive of infection [33]. Obtaining
an I/T2
ratio by dividing I/T with the total neutrophil count has
been shown to have better specificity and area under the curve
than I/T and ANC alone in diagnosing EONS [33]. An I/T2
ratio would account for both the elevated immature neutrophils
and any neutropenia which can be worrying in the background
of sepsis. The sensitivity, specificity, likelihood ratios, and the
area under the curve for ANC, I/T, and I/T2
were found to be
highest after 4 hours of birth as compared to anytime earlier
[33]. Limitations with I/T and I/T2
include the skill of the lab-
oratory personnel performing the manual counts as well as their
limited specificity. It is also important to note that there are
multiple variables that can affect the various components of
WBC, including a crying neonate, gestational age, and arterial
versus venous sample [34].
Blood culture remains the gold standard for confirmation
of sepsis but is limited by low sensitivity and duration of time
before a culture is determined to be positive (often around 24
to 72 hours). Fastidious organisms, maternal antibiotics, and
small sample collection limit the sensitivity of blood cultures.
False positives may occur due to inadequate skin antisepsis
prior to sample collection. At least 0.5 mL of blood should be
collected to improve the diagnostic yield. Samples should be
collected from two different sites to reduce false positive re-
sults. If a central venous catheter is present, blood culture
should be taken from both the line and a separate peripheral
source, to assess for the differential time to positivity. This
helps in distinguishing catheter-associated infections from
other sources of infection, which has implications in clinical
management.
Swab cultures from surface sites such as the eyes, ears,
umbilicus, groin, throat, pharynx, and rectum may provide
information about colonizing organisms. They, however, do
not contribute to the decision on starting antibiotics, especially
if the neonate appears well on clinical examination. Placental
Table 1 EONS prediction calculator variables
1) Incidence of early onset sepsis per thousand live births.
2) Gestational age
3) Highest maternal antepartum temperature
4) Duration of rupture of membranes
5) Maternal GBS status
6) Type of intrapartum antibiotics (broad spectrum vs GBS specific) and
the timing of administration in relation to birth.
Adapted from https://neonatalsepsiscalculator.kaiserpermanente.org/
InfectionProbabilityCalculator.aspx
Curr Emerg Hosp Med Rep (2019) 7:83–90 85
4. cultures may indicate the possible pathogen the fetus was
exposed to but does not indicate infection [21]. Placental cul-
ture results should not, therefore, be used as a reason for an-
tibiotic therapy. Urinary tract infections are uncommon in the
first 72 hours of life. Urine cultures are therefore only per-
formed in the evaluation of LONS [35]. Lumbar puncture
(LP) should be routinely performed in neonates showing signs
of EONS or LONS. About 23% of neonates with culture-
positive bacteremia will have concomitant meningitis [36]. If
LP has not been performed in a neonate whose blood culture is
positive, it should be performed promptly. Negative blood
cultures do not rule out meningitis, as 38% of these individ-
uals will have positive cerebrospinal fluid (CSF) gram stain or
culture [37]. False negative CSF gram stain and culture may
occur in neonates treated with antibiotics prior to LP.
Acute phase reactants such as C-reactive protein (CRP),
procalcitonin, interleukin levels (IL-6 and IL-8), presepsin,
haptoglobin, and neutrophil CD64 have been investigated as
potential biomarkers for neonatal sepsis. CRP may not be
elevated in early stages of infection, due to the time taken
for its synthesis in the liver and eventual appearance in the
blood. Serial measurements of CRP combined with other
acute phase reactants such as procalcitonin, IL-6, and IL-8
may improve its diagnostic accuracy [38].
Procalcitonin (PCT) is more specific than CRP for bacterial
infections and rises more rapidly in response to infection than
CRP. In normal birth weight infants, a PCT level greater than
0.5 ng/mL is associated with a nosocomial infection, whereas
a level of greater than 2.4 ng/mL in VLBW infants should
prompt antibiotic therapy [39]. It has been shown that
procalcitonin-guided decision making is superior to standard
care in reducing antibiotic therapy in neonates with suspected
EONS [40]. PCT levels, however, can be elevated with non-
infectious conditions such as respiratory distress syndrome,
pneumothorax, intracranial hemorrhage, and hemodynamic
instability [41]. Serial PCT concentration may be of utility in
the evaluation of neonatal sepsis although PCT physiological-
ly increases in the absence of infection over the first 48 hours
of life [42, 43].
Presepsin has been found to have a high level of diagnostic
accuracy and has been recommended as a valuable marker in
neonatal sepsis, albeit not as a single diagnostic test [44•]. A
meta-analysis performed to investigate the potential of IL-6
concluded that it could be used as a valid marker for early
diagnosis of sepsis in neonatal care units [45].
Newer Diagnostic Techniques
Automated blood culture systems monitor continuously for
positive signals, which improves time to detection of patho-
gens. Matrix-assisted laser desorption ionization time-of-
flight (MALDI-TOF) mass spectroscopy can identify
organisms in blood cultures much earlier, allowing antibiotic
therapy specific to the organism(s) involved [46]. Multiplex
polymerase chain reaction (PCR) can detect the identity of the
bacteria or fungi, as well as the presence of antimicrobial
resistance genes within hours of identification of the pathogen
[47].
PCR can be performed on blood and other body fluids
directly without the need to first culture causative organisms.
Quantitative real-time amplification systems, known as
qPCR, can be used to rapidly rule out the presence of organ-
isms in body fluids, considering its high negative predictive
value and a short time to results. The technique is based on
16S ribosomal deoxyribonucleic acid (DNA) amplification.
qPCR utilizes a small sample volume and can be used for
other bodily fluids such as pleural or peritoneal fluid.
Disadvantages include the inability to perform antibiotic sus-
ceptibility testing, difficulty in differentiating a recent infec-
tion from an active infection, and the presence of contami-
nants that can give false positive results. Hence, clinical cor-
relation should be made in the interpretation of these results.
Treatment and Management
Management varies depending on a number of factors includ-
ing age, site of infection, suspected causative organism, mi-
crobial resistance patterns, and available resources. Consensus
among authors exists that antibiotic therapy should be initiated
as soon as neonatal sepsis is suspected, but there is no con-
sensus regarding duration of treatment.
EONS Empiric Antibiotic Therapy
Recommendations from the Canadian Pediatric Society (CPS)
and the AAP recommend initiating antibiotic therapy if clini-
cal symptoms are present, with the AAP also recommending
antibiotics in the presence of abnormal laboratory values or
more than one risk factor (Table 2) [48]. The presence of
maternal chorioamnionitis with no neonatal clinical signs war-
rants antibiotic initiation as per the AAP and only if present
with laboratory abnormalities per the CPS. The US Center for
Disease Control and Prevention (CDC) recommends empiric
antibiotic therapy for all newborns with a maternal diagnosis
of chorioamnionitis, regardless of the infant’s clinical condi-
tion [48, 49]. Reevaluation at 48 hours and discontinuation of
antibiotics if infection was unlikely was universally recom-
mended [48].
Antibiotic therapy should include intravenous ampicillin
for GBS, and coverage for Escherichia coli and other gram-
negative bacteria implicated in neonatal sepsis, such as genta-
micin, with local antibiotic resistance patterns considered [49,
50]. The routine empirical use of broad-spectrum antibiotic
agents should only be considered among term newborn
86 Curr Emerg Hosp Med Rep (2019) 7:83–90
5. infants who are critically ill until culture results are available.
Elective genetic testing prior to aminoglycoside use is increas-
ingly being considered to decrease the incidence of permanent
hearing loss [51]. Further studies are required as this has not
been evaluated in the neonatal setting. In low-resource set-
tings, or when hospitalization is not possible, the use of intra-
muscular gentamicin and oral amoxicillin in lieu of intrave-
nous medications has been recommended [52].
Treatment of LONS
Early diagnosis, appropriate antibiotic administration, and time-
ly supportive management are the keys to successful treatment
[53]. Most cases are attributable to Staphylococcus species and
GBS, but about one-third are caused by gram-negative organ-
isms. Most empiric antibiotic regimens include ampicillin, a
third-generation cephalosporin, or meropenem, plus an amino-
glycoside or vancomycin. In preterm infants, the most common
isolates are CONS [54]. Vancomycin and teicoplanin are the
antibiotics of choice for a proven and significant CONS infec-
tion, but their excessive use has been associated with the devel-
opment of vancomycin-resistant enterococcus (VRE) infections
and gram-negative infections. Their use as first-line antibiotics
for nosocomial infection should be avoided. A combination of
flucloxacillin and gentamicin can be used to treat the majority
of cases caused by other organisms [51]. Clindamycin or met-
ronidazole are sometimes added to cover anaerobic organisms
in cases of necrotizing enterocolitis. Cefotaxime is commonly
reserved for the treatment of infants with meningitis [53].
Infants with risk factors for candidal sepsis should receive fun-
gal empiric therapy [10].
Treatment with a beta-lactam or beta-lactamase inhibitor com-
bined with an aminoglycoside for Enterobacter, Serratia, or
Pseudomonas sepsis is recommended by many experts [53].
Meropenem is recommended for preterm infants with systemic
extended-spectrum beta-lactamase infections. In one study,
prolonged intravenous infusion of meropenem (over 4 hours
every 8 hours) in neonates with gram-negative LONS was asso-
ciated with better clinical outcome compared to the conventional
strategy (over 30 min every 8 h) [55].
Proven Bacterial Sepsis Without Meningitis
In blood culture-proven sepsis, it is reasonable to treat for 10–14
days. A shorter duration (7–10 days) of treatment may be con-
sidered in select situations, provided appropriate follow-up can
be ensured [56]. Serial daily blood cultures should be performed
until blood cultures are negative. Serial CRP measurements may
also be used in deciding to discontinue antibiotics [56, 57]. An
infant with symptoms can have a false-negative blood culture if
antibiotics are given prenatally to the mother or if the blood
sample is collected improperly. Hence, antibiotics should be con-
tinued for symptomatic infants and those with positive blood
culture [56]. Continuing empirical antibiotic therapy in response
to laboratory test abnormalities alone is rarely justified, particu-
larly among well-appearing term infants [50]. Prolonged duration
of initial empirical antibiotic treatment has been associated with
death and necrotizing enterocolitis among premature infants [58].
In resource-poor countries, empiric antibiotic therapy
should be individualized for each hospital or region [56].
Consultation with a pediatric infectious disease specialist is
warranted for failure of sterilization of the bloodstream (i.e.,
resistant or atypical organisms) and site-specific infections
[50]. The use of pentoxifylline in neonatal sepsis was demon-
strated to significantly decrease all-cause mortality during
hospital stays in underdeveloped or developing countries,
which warrants further investigation in large randomized clin-
ical trials in capable countries [53].
Hydrocortisone has cytokine-suppressing effects, and may
improve patient’s cardiovascular status, but has not been
Table 2 Empiric antibiotic recommendations from the Canadian Pediatric Society and the American Academy of Pediatrics
Canada AAP
RF - Intrapartum GBS colonization
- GBS bacteriuria during the current pregnancy
- Previous infant with invasive GBS disease
- PROM ≥ 18 h
- Maternal fever (temperature ≥ 38 °C)
- GBS colonization without abx
- PROM ≥ 18 h
- Chorioamnionitis
Labs Infants should be investigated and treated using an individualized
approach that includes consideration of the severity of risk
factors and maternal abx therapy.
At minimum, infants should have close observation in hospital
for at least 24 h with vital signs every 3 to 4 h and reassessment
before discharge.
A CBC done after 4 h of age may be helpful; WBC < 5 × 109
/L
and ANC < 1.5 × 109
/L have the highest positive predictive
value. Some infants may warrant investigation and antibiotic
therapy. (Weak recommendation, low quality evidence.)
- WBC/diff ± CRP at 6–12 h
Curr Emerg Hosp Med Rep (2019) 7:83–90 87
6. evaluated in prospective randomized clinical trials for the treat-
ment of neonatal septic shock [53]. Immunotherapeutic interven-
tions such as intravenous immunoglobulin (IVIG) infusion, IgM-
enriched intravenous immunoglobulin, and granulocyte-
macrophage colony-stimulating factor are not recommended
[53].
Bacterial Meningitis
Intensive care with maintenance of cerebral perfusion, oxy-
genation, and prevention of hypoglycemia are crucial aspects
of management [53]. Combinations of ampicillin, cefotaxime,
and aminoglycosides have been suggested by different au-
thors [51, 53, 56]. Cefotaxime plus an aminoglycoside is a
good choice for the initial treatment of gram-negative menin-
gitis, due to adequate central nervous system (CNS) penetra-
tion. Ceftriaxone may increase the risk of kernicterus in the
first week of life and is to be avoided in that age range [59].
For uncomplicated meningitis, the duration of treatment is 14
days for GBS, Listeria monocytogenes, and Streptococcus
pneumoniae, and 21 days for Pseudomonas aeruginosa and
gram-negative enteric bacteria such as Escherichia coli.
Longer duration of therapy is recommended in complicated
cases or for delayed clinical improvement [60]. Consultation
with a pediatric infectious disease specialist is warranted for
cases that are complicated by meningitis. Neuroimaging op-
tions include cranial sonography and magnetic resonance im-
aging and may provide prognostic information [53].
Herpes Simplex Virus (HSV) Infection
Empiric treatment with intravenous acyclovir (20 mg/kg/dose
every 8 h) is recommended in cases of aseptic meningitis or
suspected meningoencephalitis. Dosage adjustments are war-
ranted in patients less than 34 weeks gestational age or in
patients with significant hepatic or renal failure. Treatment is
continued for 14 days in localized infections, or 21 days for
disseminated disease or CNS infections. In all cases of neona-
tal HSV, suppressive therapy with acyclovir (300 mg/m2
per
dose, orally, 3 times per day for 6 months) immediately fol-
lowing parenteral treatment may improve outcomes in CNS
disease and reduce recurrence [53].
Congenital Pneumonia
Prompt diagnosis with recognition of risk factors, early ad-
ministration of antibiotics, and supportive treatment are im-
portant for successfully treating congenital pneumonia.
Commonly used antibiotics include ampicillin and gentami-
cin. Cephalosporins may be considered with failure of therapy
with the aforementioned drugs or if Streptococcus
pneumoniae is suspected. Supportive therapy includes
surfactant replacement and nitric oxide inhalation for persis-
tent pulmonary hypertension of the newborn [53].
Prevention Strategies
The only proven preventive strategy for EONS is the appro-
priate administration of maternal IAP [50]. Measures that have
been postulated to decrease neonatal infection in intensive
care units include the consumption of 50 mL/kg/day of fresh
(non-donor) human milk, and probiotics, as well as the restric-
tion of H2-blockers, fluconazole, and lactoferrin [61]. Neither
GBS IAP nor the aforementioned preventive measures will
prevent bacterial LONS [50]. Guidelines for prevention of
perinatal transmission of HSV recommend cesarean delivery
for women with active genital lesions or prodromal symp-
toms. It is also recommended that pregnant women with a
history of genital herpes infection begin taking oral suppres-
sive therapy at 36 weeks of gestation [62].
Conclusion
Though rates of neonatal sepsis have declined in some parts of
the world, globally, it continues to be a significant problem.
Testing modalities for the identification and diagnosis of neona-
tal sepsis continue to be developed, with new laboratory tech-
niques still being tested. Monitoring and management of risk
factors as well as IAP remain highly important in the prevention
and control of infection in this vulnerable population. Treatment
includes prompt antibiotic administration and supportive care in
the appropriate hospital setting. Continued vigilance will be key
in the diagnosis and management of neonatal sepsis.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Human and Animal Rights and Informed Consent This article does not
contain any studies with human or animal subjects performed by any of
the authors.
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