IM Antibiotics for Secondary Prevention of Neonatal Sepsis
IM Antibiotics for Secondary Prevention of Neonatal Sepsis
Objective: To evaluate the safety, efficacy and cost–benefit of intramuscular (IM) antibiotics administration in the secondary prevention of suspected neonatal sepsis in asymptomatic term neonates.
Study Design: Retrospective review of inborn asymptomatic full-term neonates with birth weights ≥2000 g who required sepsis evaluation and treatment with IM antibiotics were undertaken from July 2001 to July 2008. The IM antibiotic protocol was categorized as inadequate if the neonate became symptomatic, had positive blood or cerebrospinal fluid (CSF) cultures or was readmitted for sepsis within 2 weeks of nursery discharge. Data were analyzed to identify relationships between key indicators for the presence of neonatal bacterial infection, 'inadequate IM antibiotics protocol' and the rehospitalization rates.
Result: There were 29 698 infants admitted to the newborn nursery (NBN) during the study period. A total of 5045 infants (17%) were evaluated for suspected neonatal sepsis; 421 neonates (8.3%) were treated with IM antibiotics for 48 to 72 h. Fourteen infants (3.3%) met criteria for 'inadequate IM antibiotics protocol'. Seven infants developed symptoms within the first 32 h of life, and seven infants had positive blood or CSF cultures, one of whom required rehospitalization. None of the infants were hemodynamically unstable or developed complications, including adverse events associated with IM drug administration.
Conclusion: Use of IM antibiotics is a safe alternative to intravenous antibiotics in the secondary prevention of asymptomatic term newborns with presumed sepsis. There is a substantial cost savings in caring for asymptomatic neonates with presumed sepsis in the NBN compared with neonatal intensive care unit costs.
In the US, suspected neonatal early onset sepsis (EOS) or sepsis syndrome is one of the most common diagnoses among term infants admitted to the neonatal intensive care unit (NICU). While care of preterm infants consumes a significant portion of the resources and personnel time in most NICU's, the number of term infant admissions to the NICU for treatment of suspected sepsis occurs 5 to 10 times more often than admissions of preterm infants. Between 4.4 and 10.5% of all infants born in the US (130 000 to 400 000 per year) receive systemic antibiotics. The incidence of EOS, defined as blood or cerebrospinal fluid (CSF) culture-proven infection occurring in the newborn younger than 7 days of age, has declined dramatically over the past 20 years from 1.7 cases per 1000 live births in early 1990's to <0.34 to 0.37 cases per 1000 live births since widespread implementation of the Centers for Disease Control (CDC) and Prevention Perinatal Group B Streptococcus (GBS) consensus guidelines.
Although most hospitals follow CDC guidelines for the evaluation and treatment of symptomatic infants, practice variation exists in the approach to infants with suspected sepsis. Many institutions admit neonates requiring evaluation for infection to the NICU and administer intravenous (IV) antibiotics until blood and/or CSF cultures are reported as negative for 48 to 72 h.
It has been our practice to manage asymptomatic, well-appearing newborns with risk factors for EOS in the regular newborn nursery (NBN). Secondary prevention of EOS is provided with intramuscular (IM) antibiotics following either a limited or full diagnostic evaluation until cultures of blood and/or CSF are negative for 48 to 72 h. This approach permitted asymptomatic infants to remain with their mothers and reduced the utilization of NICU resources for asymptomatic infants. Symptomatic neonates as well as those newborn infants with positive blood and/or CSF cultures are admitted to the NICU for IV antibiotic therapy.
We analyzed our data retrospectively to examine whether our practice of secondary prevention of EOS with IM antibiotics was justified, safe and cost-effective.
Abstract and Introduction
Abstract
Objective: To evaluate the safety, efficacy and cost–benefit of intramuscular (IM) antibiotics administration in the secondary prevention of suspected neonatal sepsis in asymptomatic term neonates.
Study Design: Retrospective review of inborn asymptomatic full-term neonates with birth weights ≥2000 g who required sepsis evaluation and treatment with IM antibiotics were undertaken from July 2001 to July 2008. The IM antibiotic protocol was categorized as inadequate if the neonate became symptomatic, had positive blood or cerebrospinal fluid (CSF) cultures or was readmitted for sepsis within 2 weeks of nursery discharge. Data were analyzed to identify relationships between key indicators for the presence of neonatal bacterial infection, 'inadequate IM antibiotics protocol' and the rehospitalization rates.
Result: There were 29 698 infants admitted to the newborn nursery (NBN) during the study period. A total of 5045 infants (17%) were evaluated for suspected neonatal sepsis; 421 neonates (8.3%) were treated with IM antibiotics for 48 to 72 h. Fourteen infants (3.3%) met criteria for 'inadequate IM antibiotics protocol'. Seven infants developed symptoms within the first 32 h of life, and seven infants had positive blood or CSF cultures, one of whom required rehospitalization. None of the infants were hemodynamically unstable or developed complications, including adverse events associated with IM drug administration.
Conclusion: Use of IM antibiotics is a safe alternative to intravenous antibiotics in the secondary prevention of asymptomatic term newborns with presumed sepsis. There is a substantial cost savings in caring for asymptomatic neonates with presumed sepsis in the NBN compared with neonatal intensive care unit costs.
Introduction
In the US, suspected neonatal early onset sepsis (EOS) or sepsis syndrome is one of the most common diagnoses among term infants admitted to the neonatal intensive care unit (NICU). While care of preterm infants consumes a significant portion of the resources and personnel time in most NICU's, the number of term infant admissions to the NICU for treatment of suspected sepsis occurs 5 to 10 times more often than admissions of preterm infants. Between 4.4 and 10.5% of all infants born in the US (130 000 to 400 000 per year) receive systemic antibiotics. The incidence of EOS, defined as blood or cerebrospinal fluid (CSF) culture-proven infection occurring in the newborn younger than 7 days of age, has declined dramatically over the past 20 years from 1.7 cases per 1000 live births in early 1990's to <0.34 to 0.37 cases per 1000 live births since widespread implementation of the Centers for Disease Control (CDC) and Prevention Perinatal Group B Streptococcus (GBS) consensus guidelines.
Although most hospitals follow CDC guidelines for the evaluation and treatment of symptomatic infants, practice variation exists in the approach to infants with suspected sepsis. Many institutions admit neonates requiring evaluation for infection to the NICU and administer intravenous (IV) antibiotics until blood and/or CSF cultures are reported as negative for 48 to 72 h.
It has been our practice to manage asymptomatic, well-appearing newborns with risk factors for EOS in the regular newborn nursery (NBN). Secondary prevention of EOS is provided with intramuscular (IM) antibiotics following either a limited or full diagnostic evaluation until cultures of blood and/or CSF are negative for 48 to 72 h. This approach permitted asymptomatic infants to remain with their mothers and reduced the utilization of NICU resources for asymptomatic infants. Symptomatic neonates as well as those newborn infants with positive blood and/or CSF cultures are admitted to the NICU for IV antibiotic therapy.
We analyzed our data retrospectively to examine whether our practice of secondary prevention of EOS with IM antibiotics was justified, safe and cost-effective.
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