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Early-onset sepsis risk in infants linked to maternal risk factors
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A recent study presents strategies for evaluating and treating early-onset sepsis in term and late preterm infants by combining maternal data and neonatal clinical findings.
Between 1993 and 2007, researchers collected data from a baseline population of 608,014 live births, of which 350 had early-onset sepsis for the study published in Pediatrics. The control group consisted of 1,063 infants. Race, date and time of birth, birth weight, gestational age, Apgar scores, delivery method, whether the infant required resuscitation at birth, and clinical and treatment milestones such as timing of seizures and antibiotic treatment were significant data points.
Researchers found that infants with early-onset sepsis had lower gestational age, birth weight, and Apgar scores. Significant clinical signs and major deteriorations tended to occur early on, before infants were aged 6 hours.
Combining clinical data and maternal risk factors, researchers calculated the infants’ sepsis risk at birth. Infants considered high-risk had a sepsis incidence rate greater than or equal to 1.54 (for every 1,000 live births) and represented 4% of patients. Infants who had a sepsis risk greater than or equal to 0.65 represented 11% of patients. Low-risk infants accounted for 85% of study participants and had a sepsis risk less than 0.65.
Researchers recommended infants with a sepsis risk of 0.65 or more receive blood tests and more frequent examinations. Patients considered high risk should receive immediate antibiotic treatment pending culture results.
“We have developed a quantitative risk-stratification strategy of the risk of [early-onset sepsis] in newborns ≤34 weeks’ gestation that combines maternal risk factors with a newborn’s evolving clinical examination. Because maternal risk factors could be captured and analyzed electronically in real time, it can take maximum advantage of modern electronic medical records,” Gabriel J. Escobar, MD, from the Kaiser Permanente Medical Center, and colleagues concluded. “Further, our strategy is not restricted to [group B Streptococcus] sepsis. It could supplement existing care protocols by permitting clinicians to group infants into discrete, risk-based, subsets.”
Disclosure: The researchers report no relevant financial disclosures.
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