TY - JOUR
T1 - Safety of physical examination alone for managing well-appearing neonates ≥35 weeks gestation at risk for early-onset sepsis
AU - Berardi, Alberto
AU - Fornaciari, Sara
AU - Rossi, Cecilia
AU - Patianna, Viviana
AU - Bacchi Reggiani, Maria Letizia
AU - Ferrari, Filippo
AU - Neri, Isabella
AU - Ferrari, Fabrizio
PY - 2015/7/3
Y1 - 2015/7/3
N2 - Objective: The published data to support recommendations for prevention and management of well-appearing at-risk newborns (WAARNs) for early-onset sepsis (EOS) are limited.Methods: Retrospective cohort study comparing two different strategies for managing WAARNs (≥35 weeks gestation) during a 6-year period (Period 1, from 2005 to 2007; Period 2, from 2009 to 2011). WAARNs were defined as healthy-appearing neonates evaluated because of risk factors for EOS. Laboratory evaluation plus simplified physical examination (Period 1) was compared with physical examination alone (PEA, Period 2). The use of antibiotics, the length of stay, the timeliness of diagnosis and the risk of falling ill immediately after hospital discharge in both periods were also compared.Results: WAARNs receiving empirical antibiotics were 14/500 (Period 1) and 3/500 (Period 2, p = 0.01). Median length of stay was 4 (Period 1) and 3 days (Period 2, p = 0.04). Symptoms of EOS were earlier than laboratory evaluation results in 42/44 neonates. Severe disease was diagnosed within 6 h of life in all neonates. No WAARNs presented with EOS following hospital discharge.Conclusions: WAARNs managed through PEA received less unnecessary antibiotics and had a shorter length of stay. They had no increased risk of severe complications or increased risk of becoming ill following hospital discharge.
AB - Objective: The published data to support recommendations for prevention and management of well-appearing at-risk newborns (WAARNs) for early-onset sepsis (EOS) are limited.Methods: Retrospective cohort study comparing two different strategies for managing WAARNs (≥35 weeks gestation) during a 6-year period (Period 1, from 2005 to 2007; Period 2, from 2009 to 2011). WAARNs were defined as healthy-appearing neonates evaluated because of risk factors for EOS. Laboratory evaluation plus simplified physical examination (Period 1) was compared with physical examination alone (PEA, Period 2). The use of antibiotics, the length of stay, the timeliness of diagnosis and the risk of falling ill immediately after hospital discharge in both periods were also compared.Results: WAARNs receiving empirical antibiotics were 14/500 (Period 1) and 3/500 (Period 2, p = 0.01). Median length of stay was 4 (Period 1) and 3 days (Period 2, p = 0.04). Symptoms of EOS were earlier than laboratory evaluation results in 42/44 neonates. Severe disease was diagnosed within 6 h of life in all neonates. No WAARNs presented with EOS following hospital discharge.Conclusions: WAARNs managed through PEA received less unnecessary antibiotics and had a shorter length of stay. They had no increased risk of severe complications or increased risk of becoming ill following hospital discharge.
KW - Group B Streptococcus
KW - intrapartum antibiotic prophylaxis
KW - management
KW - neonatal sepsis
KW - prevention
UR - http://www.scopus.com/inward/record.url?scp=84940648659&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84940648659&partnerID=8YFLogxK
U2 - 10.3109/14767058.2014.946499
DO - 10.3109/14767058.2014.946499
M3 - Article
C2 - 25034325
AN - SCOPUS:84940648659
VL - 28
SP - 1123
EP - 1127
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
SN - 1476-7058
IS - 10
ER -