These resources were developed by the OASCN Collaborative between 2021-2022.
Relevant Didactics:
- Use of Inflammatory Markers for Evaluating Early and Late Onset Sepsis (Bill Benitz): Slides | Video
- Early onset sepsis in neonates: It’s all about the exam, baby! (Adam Frymoyer): Slides | Video
- Antimicrobial Stewardship in Preterm Infants (Bill Benitz): Slides | Video
Relevant Learning Points:
Learning Point #1: I:T ratio, procalcitonin, and CRP are of very limited use for EOS given low positive predictive value. Not a required part of sepsis evaluation; should only be used “with caution” for EOS evaluations.
- CRP continues to rise for at least 48 hours in healthy asymptomatic newborns.
- Consistently normal values of CRP and procalcitonin over the first 48 HOL are associated with the absence of EOS. Serial abnormal values alone should not be used to decide whether to administer antibiotics in the absence of culture-confirmed infection (low PPV).
Learning Point #2: Adjusting CSF WBC count (per peripheral CBC ratio) to correct for blood in CSF is not validated. Use with caution.
Learning Point #3: CSF PCR is underutilized. Consider using in all rule out meningitis cases. The BioFire platform detects 14 pathogens.
Learning Point #4: CSF PCR sensitivity is higher than culture when done early in course, but less sensitive if obtained a few days into therapy (as with culture). Other CSF indices will remain positive for many days after therapy; eg, pleocytosis or high protein (glucose will more rapidly normalize).
Relevant References
Cantey JB et al. Biomarkers for the diagnosis of neonatal sepsis. Clin Perinatol 2021;48:215-227.
Rub DM et al. Role of microbiological tests and biomarkers in antibiotic stewardship. Semin Perinatol 2020 Oct 12:151328.
Weitkamp J-H. The role of biomarkers in suspected neonatal sepsis. 2020 Clin Infect Dis ep 3:ciaa869. doi: 10.1093/cid/ciaa869. Online ahead of print.
Perrone S et al. C-reactive protein in healthy term newborns during the first 48 hours of life. Arch Dis Child Fetal Neonatal Ed 2018;103;F163-6.
Singh N et al. Antibiotic stewardship in NICU: De-implementing routine CRP to reduce antibiotic usage in neonates at risk for early-onset sepsis. J Perinatol 2021; 41:2488-2494.
Gyllensvärd et al. C-reactive protein- and clinical symptoms guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative. BMC Pediatrics (2020) 20:531
Greenberg RG et al. Traumatic lumbar punctures in neonates: test performance of the cerebrospinal fluid white blood cell count. PIDJ 2008;27:1047-51.