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Serial physical examinations, a simple and reliable tool for managing neonates at risk for early-onset sepsis

World Journal of Clinical Pediatrics 2016年第4期5卷 358-364页

作者： Alberto Berardi anna maria buffagni Cecilia Rossi Eleonora Vaccina Chiara Cattelani Lucia Gambini Federica Baccilieri Francesca Varioli Fabrizio Ferrari Neonatal Intensive Care Unit Department of Mother and Child Policlinic University Hospital Neonatal Intensive Care Unit Department of Obstetric and Pediatric Arcispedale Santa Maria Nuova

AIM To investigate whether serial physical examinations(SPEs) are a safe tool for managing neonates at risk for early-onset sepsis(EOS). METHODS This is a retrospective cohort study of neonates(≥ 34 wks' gestation) delivered in three high-volume level Ⅲbirthing centres in Emilia-Romagna(Italy) during a 4-mo period(from September 1 to December 31, 2015). Neonates at risk for EOS were managed according to the SPEs strategy, these were carried out in turn by bedside nursing staff and physicians. A standardized form detailing general wellbeing, skin colour and vital signs was filled in and signed at standard intervals(at age 3, 6, 12, 18, 36 and 48 h) in neonates at risk for EOS. Three independent reviewers reviewed all charts of neonates and abstracted data(gestational age, mode of delivery, group B streptococcus status, risk factors for EOS, duration of intrapartum antibiotic prophylaxis, postpartum evaluations, therapies and outcome). Rates of sepsis workups, empirical antibiotics and outcome of neonates at-risk(or not) for EOS were *** There were 2092 live births and 1 culture-proven EOS(Haemophilus i)(incidence rates of 0.48/1000 live births). Most newborns with signs of illness(51 out of 101, that is 50.5%), and most of those who received postpartum antibiotics(17 out of 29, that is 58.6%) were not at risk for EOS. Compared to neonates at risk, neonates not at risk for EOS were less likely to have signs of illness(51 out of 1442 vs 40 out of 650, P = 0.009) or have a sepsis workup(25 out of 1442 vs 28 out of 650, P < 0.001). However, they were not less likely to receive empirical antibiotics(17 out of 1442 vs 12 out of 650, P = 0.3). Thirty-two neonates were exposed to intrapartum fever or chorioamnionitis: 62.5%(n = 20) had a sepsis workup and 21.9%(n = 7) were given empirical antibiotics. Among 216 neonates managed through the SPEs strategy, only 5.6%(n = 12) had subsequently a sepsis workup and only 1.9%(n = 4) were given empirical antibiotics. Al

关键词： Sepsis Group B streptococcus Intrapartum antibiotic prophylaxis Newborn Prevention

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