Sepsis Screening of Newborns . . . . One Approach

Identifying newborn at increased risk of sepsis and deciding which ones to evaluate further is not easy.  It is true that the risk of sepsis is greater for infants with multiple risk factors or  clinical signs than for those with only a single indicator of possible infection; however, there is no simple way to estimate the magnitude of the risk implied by any particular combination of historical findings or clinical signs.  We suggest the  guidelines below.

Evaluating for Sepsis Risk

Specific Risk Factors

Management Recommendations

In the following situations, the infant should have a complete diagnostic evaluation and empiric antibiotic therapy:

• history of a prior infant with GBS sepsis
• preterm premature rupture of membranes
• maternal clinical chorioamnionitis
• infants in a multiple birth group if one is diagnosed with GBS sepsis

In all other situations, you must perform a risk assessment.

• The following is one way to assess common risk factors, based on odds ratios (O.R.) for developing neonatal sepsis when a single factor is present.

• These recommendations are only a guide, and are not meant to be a substitute for a physical examination or sound clinical judgment.

• Any newborn infant with clinical signs of sepsis should be considered for admission for full sepsis evaluation. 

• CRP has good positive predictive value only at levels >5 mg/L and good negative predictive value if tested serially and level is <1 mg/L each time.

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Low Risk Criteria for Sepsis (OR <3.0)

Cyanosis

Tachypnea

Hypotonia

Hyperreflxia

Mec stained fluid

Preterm onset labor

Grunting

Hyperbilirubinemia >24h

Seizures

Retractions

Lethargy

Poor feeding

 

Moderate Risk Criteria for Sepsis (OR >3.0 but <6.0)

Diarrhea

Apgar <6 @ 5 minutes

Apnea

Splenomegaly

Maternal fever >37.5 C

Rash

Distended Abdomen

Hypertension

Hypotension

Bulging Fontanel

EGA 34-36 weeks

 

High Risk Criteria for Sepsis (OR >6)

Pustules

Bleeding

PROM >18 hours

Decreased perfusion

Tachycardia

Arrhythmia

Vasomotor instability

Hyperbilirubinemia <24h

Pallor

Fetal tachycardia in the 10 minutes prior to delivery

Persistent neonatal tachycardia

Cord blood pH <7.18

Twin with sepsis

 

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Any 1 Low/Moderate Risk:

Evaluate/manage clinically and continue close observation. If develops increased or new signs, sepsis screen (CBC/diff, 2 CRPs: first >8hrs of life, second >24hrs after the first). If all reassuring, continue close observation, otherwise proceed to full sepsis evaluation. If develops additional increased or new signs, admit for full sepsis evaluation.

 

Any 2 Low/Moderate Risk , or

Any 1 High Risk, or

Any 1 High Risk plus 1 additional Low Risk:

Evaluate/manage clinically and perform sepsis screen (CBC/diff, 2 CRPs: first >8hrs of life, second >24hrs after the first). If all reassuring, continue close observation, otherwise proceed to full evaluation and treatment. If develops increased or new signs, admit for full sepsis evaluation.

 

Any 3 Low/Moderate Risk, or

Any 1 High Risk plus 1 Moderate Risk, or

Any 1 High Risk plus 2 Low Risk, or

Any 2 High Risk:

Admit for full sepsis evaluation.

 

ABurgos, WBenitz, reviewed 5-06

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