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Diagnosis and Treatment of Neonatal Sepsis: Reconciling

the COFN & CDC Guidelines

Ri h d A.
Richard A Polin
P li M.D.
MD
Morgan Stanley Childrens Hospital
Columbia University
Expert Panels on Neonatal Sepsis

CDC: Centers for Disease COFN: Committee on


Control and Prevention Fetus and Newborn
Guidance for the Clinician in
Rendering Pediatric Care

CLINICAL REPORT

Management of Neonates With Suspected or Proven


Morbidity and Mortality Weekly Report
www.cdc.gov/mmwr Early-Onset Bacterial Sepsis
Recommendations and Reports November 19, 2010 / Vol. 59 / No. RR-10

Prevention of Perinatal Group B


Streptococcal Disease
abstract Richard A. Polin, MD and the COMMITTEE ON FETUS AND
NEWBORN
Revised Guidelines from CDC, 2010 With improved obstetrical management and evidence-based use of KEY WORDS
early-onset sepsis, antimicrobial therapy, group B streptococcus,
intrapartum antimicrobial therapy, early-onset neonatal sepsis is be- meningitis, gastric aspirate, tracheal aspirate, chorioamnionitis,
coming less frequent. However, early-onset sepsis remains one of the sepsis screen, blood culture, lumbar puncture, urine culture,
most common causes of neonatal morbidity and mortality in the pre- body surface cultures, white blood count, acute phase reactants,
term population. The identication of neonates at risk for early-onset prevention strategies

sepsis is frequently based on a constellation of perinatal risk factors ABBREVIATIONS


CLINICAL REPORT
that are neither sensitive nor specic. Furthermore, diagnostic tests
CFUcolony-forming units
CRPC-reactive protein
for neonatal sepsis have a poor positive predictive accuracy. As a result, CSFcerebrospinal uid

Management of Neonates With Suspec


clinicians often treat well-appearing infants for extended periods of time,
even when bacterial cultures are negative. The optimal treatment of
GBSgroup B streptococci
I/Timmature to total neutrophil (ratio)

MMWR Recomm Rep. 2010; 59: Pediatrics. 2012;129(5): 1006-1015.


PMNpolymorphonuclear leukocyte

Early-Onset
infants with suspected early-onset sepsis is broad-spectrum antimicro-

Bacterial Sepsis
bial agents (ampicillin and an aminoglycoside). Once a pathogen is iden-
PPROMpreterm premature rupture of membranes
This document is copyrighted and is property of the American

1-36.
tied, antimicrobial therapy should be narrowed (unless synergism is Academy of Pediatrics and its Board of Directors. All authors
needed). Recent data suggest an association between prolonged empir- have led conict of interest statements with the American
Continuing Education Examination available at http://w ww.cdc.gov/mmwr/cme/conted.html
Academy of Pediatrics. Any conicts have been resolved through
ical treatment of preterm infants (5 days) with broad-spectrum anti- a process approved by the Board of Directors. The American
department of health and human services biotics and higher risks of late onset sepsis, necrotizing enterocolitis, Academy of Pediatrics has neither solicited nor accepted any

abstract
Centers for Disease Control and Prevention
and mortality. To reduce these risks, antimicrobial therapy should be commercial involvement in the development of the content of
Richard A. P
this publication.
discontinued at 48 hours in clinical situations in which the probability
of sepsis is low. The purpose of this clinical report is to provide a The guidance in this report does not indicate an exclusiveNEWBORN
course of treatment or serve as a standard of medical care.
practical and, when possible, evidence-based approach
With improved obstetrical management and Variations, to the manage- evidence-based usecircumstances,
taking into account individual of KEY
may be WORDS
ment of infants with suspected or proven early-onset sepsis. Pediatrics appropriate. early-onset se
intrapartum antimicrobial therapy, early-onset neonatal sepsis is be-
2012;129:10061015 meningitis, ga
coming less frequent. However, early-onset sepsis remains one of the sepsis screen
most common causes of neonatal morbidity and mortality in the pre- body surface
INTRODUCTION prevention str
term population. The identication of neonates at risk for early-onset
Epidemiologa
Clinical Spectrum of Early-onset Neonatal Sepsis
EGB el principal patgeno y E. Coli 2 en frecuencia.
There are ~3300 invasive early-onset sepsis cases and 390 deaths in the
Estimacin anual de 3.300 casos, con una mortalidad del 10%.
United states each year (2005-2008 data).
data)
GBS is the leading pathogen and E coli is second
2/3 E coli isolates are resistant to ampicillin.

Rate* Case fatality ratio


Black preterm 5.14 24.4%
Non black ppreterm 2.17 21.5%
Black term 0.89 1.7%
Non black term 0.04 1.6%

*/1,000 live births

Weston et al Pediatr. Inf Dis. J. 30: 937, 2011


(Rules) (Guideline)
Recin nacido asintomtico 37 semanas
y factores de riesgo ( corioamnionitis)

CDC
PAI Observacin
incompleta (Evaluacin opcional)

COFN
Observacin
Evaluacin limitada*

PAI CDC
incompleta Evaluacin limitada
+
HBR 18 h
COFN Observacin
*Cuando observacin no es posible Evaluacin limitada*
Yes Limited evaluation prophylaxis, if the infant is well-appearing a
t FEFmOJUJPOPGBEFRVBUFJOUSBQBSUVNBOUJC
Either <37 weeks Yesor duration
Observation for 48 hours laxis
of membrane rupture and 0is daysclarified asYes4 hours
gestational age andof IVthe penicillin,
duration
18 hours? Yes Signs of neonatal sepsis? Full diagnostic evaluation*
Mother received intravenous Observation for 48 hours cefazolin
rupture before before delivery
delivery (AII).
wasAntibiotic
<18 hours, All otherthen ag th
therapy
penicillin, ampicillin, tions
be observedare considered
No inadequate
for 48 hours, and nofor purpose
routine dia
* Fullordiagnostic
cefazolin for 4 hoursincludes a blood culture, a complete blood count
evaluation management.
is recommended (BIII). If the infant is well-
before delivery?
(CBC) including white blood cell differential and platelet counts, chest ra-
diograph (if respiratory abnormalities are present), and lumbar puncture (if
t 8FMMBQQFBSJOHJOGBOUTXIPTFNPUIFSIBEBO
either
Maternal <37 weeks
chorioamnionitis? Yes and 0 days Limitedgestational
evaluation age o
patient is stableNoenough to tolerate procedure and sepsis is suspected). GBS prophylaxis
of membrane but received
rupture before no therapy
delivery
Antibiotic or inadequat
was
18
Antibiotic therapy should be directed toward the most common causes of
Morbidity and Mortality Weekly Report
neonatal sepsis, including Yes ampicillin
intravenous Observationfor GBS andhours
for 48 coverage
for infantNoshould
antibiotics canundergo
be managed with observation
a limited evaluation an f
37 weeks and durationwww.cdc.gov/mmwr unless
other organisms
of membrane
(including Escherichia coli and other gram-negative patho- for 48the hoursinfant is <37 weeks and 0 days g
(BIII).
and shouldrupture
Recommendations and Reports November 19, 2010 / Vol. 59 / No. RR-10
gens) take into account local antibiotic resistance patterns.
GBS or membranesindicated were No
<18 hours?
Consultation with obstetric providers is important to determine the level of prophylaxis
The following keyrupturedRoutine 18
changes werehours
clinical befo
caremade fr
Prevention
clinical suspicion of Perinatal
for chorioamnionitis. Group B is diagnosed clini-
Chorioamnionitis which
for
guidelines: case
mother?** a limited evaluation and observa
No
t hours is recommended (BIII).
cally and some of the signs are
Streptococcal Disease nonspecific.
Limited evaluation includes blood culture (at birth) and CBC with differential FBMHPSJUINOPXBQQMJFTUPBMMOFXCPSOT
Yes
and platelets Revised
(at orbirthGuidelines
and/or at 612 Yes
fromhours CDC,of2010 life).
Limited evaluation
t
t 8FMMBQQFBSJOHJOGBOUTXJUIBHFTUBUJPOBMBHFPG
FEFmOJUJPOPGBEFRVBUFJOUSBQBSUVNBOUJ
Either <37 weeks duration
** See table 3 for indications for intrapartum GBS
of membrane rupture
prophylaxis.
Observation for 48 hours whose
laxis is mothers
clarified received
Yes4 hours
as adequate
of IV intrapartu
penicillin,

If signs of sepsis develop, a full diagnostic evaluation should be conducted Motherprophylaxis
received intravenous Observation for 48 hours
18 hours?
and antibiotic therapy initiated. cefazolin do not routinely require
before delivery (AII). All other ag diagnost
If 37 weeks gestation, observation may occur at home after 24 hours if other penicillin,
(CIII). ampicillin,
discharge criteria have been met, access to medical care is readily available, tionsforare
or cefazolin considered inadequate for purpos
4 hours
* Full
anddiagnostic
a person who evaluation
is able to includes
complyafully bloodwith culture, a complete
instructions blood
for home count
observa- management.
before delivery?
tion will
(CBC) be present.
including whiteIfbloodany ofcell these conditions
differential andis not met, the
platelet infant
counts, should
chest ra- Monitoring Implementation
t 8FMMBQQFBSJOHJOGBOUTXIPTFNPUIFSIBEBO
be observed
diograph in the hospital
(if respiratory for at leastare
abnormalities 48present),
hours and until
and discharge
lumbar criteria
puncture (if
are achieved.
patient is stable enough to tolerate procedure and sepsis is suspected). and GBS Impactprophylaxisof
No
but Guidelines
received no or inadequa
Antibiotic
Some experts therapy recommend
should bea directed
CBC withtoward differential and platelets
the most common at causes
age 612 of
hours. sepsis, including intravenous ampicillin for GBS and coverage for antibiotics can be managed with observation
t -PDBMBOETUBUFQVCMJDIFBMUIBHFODJFT JODPO
neonatal Yes
other organisms (including Escherichia coli and other gram-negative patho- unless
37 weeks the infant
and duration
appropriate groupsisof<37 Observation
weeksforare
hospitals, 48 hours
and 0
days g
encourage
gens) and should take into account local antibiotic resistance patterns. of membrane
or membranes
surveillancerupture for were ruptured
early-onset GBS 18disease
hoursand befo
Consultation with obstetric providers is important to determine the level of
<18 hours?
which
steps tocase
promotea limited evaluation
perinatal GBS disease and preven
observ
clinical suspicion for chorioamnionitis. Chorioamnionitis is diagnosed clini-
cally and some of the signs are nonspecific.
Limited
hoursNoistorecommended
cation reduce the incidence (BIII). of early-onset
evaluation includes blood culture (at birth) and CBC with differential
Continuing Education Examination available at http://w ww.cdc.gov/mmwr/cme/conted.html

and platelets (at birth and/or at 612 hours of life). t in


8FMMBQQFBSJOHJOGBOUTXJUIBHFTUBUJPOBMBHFP
their states (CIII).
** See table department
3 for indications for intrapartum
of health and human GBS prophylaxis.
services whose mothers Yes received adequate intrapart
If signs ofCenters
sepsis develop,
for Disease a fullControl
diagnostic and evaluation
Preventionshould be conducted Either <37 weeks or duration Limited evaluation
and antibiotic therapy initiated.
prophylaxis do not routinely Observationrequire diagnos
for 48 hours
of membrane rupture
If 37 weeks gestation, observation may occur at home after 24 hours if other (CIII).
discharge criteria have been met, access to medical care is readily available, 18 hours?
and a person who is able to comply fully with instructions for home observa-
tion will be present. If any of these conditions is not met, the infant should Monitoring Implementation
Rendering Pediatric Care

CLINICAL REPORT

Management of Neonates With Suspected or Proven


Early-Onset Bacterial Sepsis

abstract Richard A. Polin, MD and the COMMITTEE ON FETUS AND
NEWBORN
With improved obstetrical management and evidence-based use of KEY WORDS

Algoritmos de manejo del recin nacido:


intrapartum antimicrobial therapy, early-onset neonatal sepsis is be-
coming less frequent. However, early-onset sepsis remains one of the
early-onset sepsis, antimicrobial therapy, group B streptococcus,
meningitis, gastric aspirate, tracheal aspirate, chorioamnionitis,
sepsis screen, blood culture, lumbar puncture, urine culture,
most common causes of neonatal morbidity and mortality in the pre- body surface cultures, white blood count, acute phase reactants,
term population. The identication of neonates at risk for early-onset prevention strategies

1. Evaluacin Recin nacido asintomOco con factor de riesgo:


sepsis is frequently based on a constellation of perinatal risk factors
that are neither sensitive nor specic. Furthermore, diagnostic tests
ABBREVIATIONS
CFUcolony-forming units

CorioamnioniOs materna.
CRPC-reactive protein
for neonatal sepsis have a poor positive predictive accuracy. As a result, CSFcerebrospinal uid
clinicians often treat well-appearing infants for extended periods of time, GBSgroup B streptococci
I/Timmature to total neutrophil (ratio)
even when bacterial cultures are negative. The optimal treatment of PMNpolymorphonuclear leukocyte
infants with suspected early-onset sepsis is broad-spectrum antimicro-
2. Evaluacin Recin nacido asintomOco 37 semanas con factor
PPROMpreterm premature rupture of membranes
bial agents (ampicillin and an aminoglycoside). Once a pathogen is iden- This document is copyrighted and is property of the American
tied, antimicrobial therapy should be narrowed (unless synergism is Academy of Pediatrics and its Board of Directors. All authors

de riesgo: CorioamnioniOs materna.


needed). Recent data suggest an association between prolonged empir-
ical treatment of preterm infants (5 days) with broad-spectrum anti-
have led conict of interest statements with the American
Academy of Pediatrics. Any conicts have been resolved through
a process approved by the Board of Directors. The American
biotics and higher risks of late onset sepsis, necrotizing enterocolitis, Academy of Pediatrics has neither solicited nor accepted any
and mortality. To reduce these risks, antimicrobial therapy should be commercial involvement in the development of the content of

3. Evaluacin Recin nacido asintomOco 37 semanas con factor


this publication.
discontinued at 48 hours in clinical situations in which the probability
of sepsis is low. The purpose of this clinical report is to provide a The guidance in this report does not indicate an exclusive
course of treatment or serve as a standard of medical care.

de riesgo: CorioamnioniOs materna.


practical and, when possible, evidence-based approach to the manage-
ment of infants with suspected or proven early-onset sepsis. Pediatrics
Variations, taking into account individual circumstances, may be
appropriate.
2012;129:10061015

INTRODUCTION Pediatrics. 2012;129(5): 1006-1015.


Suspected sepsis is one of the most common diagnoses made in the
NICU.1 However, the signs of sepsis are nonspecic, and inammatory
syndromes of noninfectious origin mimic those of neonatal sepsis. Most
infants with suspected sepsis recover with supportive care (with or
Evaluacin Recin nacido asintomtico
Factor de riesgo: Corioamnionitis

HemoculOvo al nacer
ATB amplio
CorioamnioniOs* Hemograma PCR
espectro
6-12 horas de vida

Evaluacin


HemoculOvo HemoculOvo negaOvo HemoculOvo negaOvo
posiOvo EF normal EF normal
Laboratorio anormal Laboratorio normal

ConOnuar ATB ConOnuar ATB Suspender ATB


Puncin lumbar 48-72 horas 48 horas
si la madre ATB
durante el parto
Interpre5ng Complete Blood Counts Soon A:er Birth
In Newborns at Risk for Sepsis

Leucocitos Neutrfilos
Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic
Neonates Exposed to Suspected Chorioamnionitis?
selected f
masked th
Gregory L. Jackson, William D. Engle, Dorothy M. Sendelbach, Debra A. Vedro, Sue
Josey, Jodi Vinson, Carol Bryant, Gary Hahn and Charles R. Rosenfeld
Pediatrics 2004;113;1173

The online version of this article, along with updated information and services, is
tational ag
as eviden
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/113/5/1173.full.html

for infants
to 3667 w
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
with a ges
Indice I/T Plaquetas
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2004 by the American Academy

Third, al
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

study, th
age at the
vals of te
Downloaded from pediatrics.aappublications.org at Hospital Virgen de la Salud Biblioteca on January 2, 2013

LR we r
smaller s
cases to
FIGURE 2
around th
ROC curves for WBC counts (A), ANCs (B), I/T ratio (C), and platelet counts (D) performed at !72 hours to stratify
Newman et al. Pediatrics 126: 903-90, 2010
according to age at the time of the CBC. unable to
cific comb
Are Complete Blood Cell Counts Useful in the Evaluation of
Asymptomatic Neonates Exposed to Suspected Chorioamnionitis?

Gregory L. Jackson, MD, MBA*; William D. Engle, MD*; Dorothy M. Sendelbach, MD*; Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic
Neonates Exposed to Suspected Chorioamnionitis?
Gregory L. Jackson, William D. Engle, Dorothy M. Sendelbach, Debra A. Vedro, Sue

bra A. Vedro, PNP; Sue Josey, PNP; Jodi Vinson, PNP; Carol Bryant, PNP; Gary Hahn, PNP; and Josey, Jodi Vinson, Carol Bryant, Gary Hahn and Charles R. Rosenfeld
Pediatrics 2004;113;1173

Charles R.ofRosenfeld,
Distribution Abnormal MD* Neutrophil Values in Infants Born The online version of this article, along with updated information and services, is
located on the World Wide Web at:

to Women with Chorioamnionitis http://pediatrics.aappublications.org/content/113/5/1173.full.html

STRACT. Objective. Chorioamnionitis complicates Eight required rehospitalization; none had evidence of
to 10% of pregnancies and increases the risk of neo- bacterial infection. If neutrophil values had been used to
l infection. Women with chorioamnionitis%receive determine duration of%antibiotics,
symptomatic then local costs
asymptomatic % would
asymptomatic
apartum antibiotics, often resulting in inconclusive have increased by $76 000 to $425 000 per year. (Schelonka)
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,

(Manroe) published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2004 by the American Academy

natal blood cultures. Peripheral neutrophil values are Conclusions. Single or serial neutrophil values do not
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

d frequently to assist in the diagnosis of neonatal


I/T-1 42%assist in the diagnosis of early-onset
20% infection or deter- 6%
ction and to determine duration of antibiotics; we mination of duration of antibiotic therapy in asymptom-
ght to determine the utilityI/T-2
of this approach. 47%atic, culture-negative neonates13% who are >35 weeks ges-
ethods. A prospective observational study was per- tation and are delivered of women with suspected Downloaded from pediatrics.aappublications.org at Hospital Virgen de la Salud Biblioteca on January 2, 2013

I/T-3 25% 5%
med in 856 near-term/term neonates who were ex- chorioamnionitis. Pediatrics 2004;113:11731180; intra-
ed to suspected chorioamnionitis. Each received anti- amniotic infection, neutrophil values, complete blood
ics for 48 hours unless clinical infection or positive count, early-onset infection, antibiotic therapy, length of
Jacksonwere
od cultures occurred. Peripheral neutrophils G L et stay,
al Pediatrics 113: 1173, 2004
resource utilization.
sured serially and analyzed using the reference
ges of Manroe et al; an additional analysis of only the
al neutrophil values used the normal ranges of Sche- ABBREVIATIONS. CDC, Centers for Disease Control and Preven-
ka et al. Results of neutrophil analyses were not used tion; CBC, complete blood cell count; ATN, absolute total neutro-
phil count; ATI, immature neutrophil count; I:T, immature neu-
etermine duration of therapy. Fifty percent of asymp- trophil count:absolute total neutrophil count proportion; NBN,
atic neonates were seen postdischarge to ascertain normal newborn nursery; GBS, group B streptococcus.
Recin nacido asintomtico 37 semanas
Factor de riesgo Corioamnionitis
PAI incompleta
Observacin
o
24-48 horas
BR 18 horas

Hemograma PCR Evaluacin


6-12 horas de vida

Laboratorio normal
Laboratorio anormal EF normal
Alta a las 48 horas

HemoculOvo

HemoculOvo negaOvo Iniciar ATB


EF normal HemoculOvo posiOvo
Puncin lumbar
Alta a las 48 horas
Use of the Complete Blood Cell Count
in Early-onset Neonatal Sepsis

En un estudio con 166.092 neonatos con sospecha de sepsis


neonatal precoz.

Cuando los valores de leucocitos, neutrfilos totales, ndice I/T y


plaquetas fueron normales, solo 0,6% de los neonatos tena un
hemocultivo positivo: VPN del 95%.

Bajas cifras de leucocitos y neutrfilos totales, y altos ndices de I/T


se asocia a un riesgo aumentado de hemocultivo positivo: VPP del
20-40%.

Hornik el al Pediatr. Inf. Dis; 31: 799-802. 2012


Recin nacido asintomtico 37 semanas
Factor de riesgo Corioamnionitis

PAI incompleta HemoculOvo
o Hemograma PCR
BR 18 horas 6-12 horas de vida

Evaluacin

Laboratorio normal
Laboratorio EF normal
anormal No precisa ATB

ATB amplio espectro

HemoculOvo posiOvo
HemoculOvo negaOvo Suspender ATB
ConOnuar ATB
EF normal despus 48-72 horas
Puncin lumbar
Das de tratamiento antibitico
Duration of Antibiotic Therapy
Tratamiento antibitico 5 das, durante los primeros das de vida, ha sido
asociado con incremento de mortalidad, NEC y sepsis neonatal tarda.
Prolonged therapy with antibiotics ( 5days) in the first few days of life
has been associated with increased mortality, NEC and late onset sepsis.
with

3.5
cs
ero Days on Antibiotic
mpared with Infants w

3.0
OR for NEC,

2.5

2.0

1.5

1.0

0.5
Com
Ze

0
1 to 2 3 to 4 5 to 6 7 to 8 9 to 10 >10

Days on Antibiotics

Cotten CM and the NICHD Network Pediatrics 123: 58-66, 2009, Kuppala
VS J Pediatr. 159: 720-25, 2011, Vanaja N J Pediatr. 159: 392-97, 2011
Recomendaciones

En pacientes sintomOcos mantener tratamiento anObiOco


durante 7 das.

En 35 semanas y asintomOcos no mantener tratamiento


anObiOco ms de 48 horas.

No existen datos en las guas clnicas para los muy prematuros,


pero recomienda no mantener tratamiento anObiOco ms de 48-72
horas, s los culOvos son negaOvos y el recin nacido se encuentra
asintomOco.
Definicin de corioamnionitis
Definition of Chorioamnionitis

Elevated Histological Polymorphonuclear


cytokines or infiltration of
amniotic fluid placenta, membranes
Biochemical and umbilical cord

Microbiological

Maternal fever Clinical


tachycardia, Positive culture
leukocytosis, CRP, Positive PCR
vaginal discharge,
uterine tenderness.
Fetal tachycardia. Fetal
vasculitis
(funisitis)

Neonatal Sepsis
Corioamnionitis principal factor de riesgo
para sepsis neonatal precoz

RN 37 semanas con el diagnosOco de sepsis neonatal precoz, corioamnioniOs fue


Chorioamnionitis and the Risk of Neonatal Sepsis
documentada en el 35% (histolgicamente el 90%).

in Premature
CorioamnioniOs inversamente proporcional a Infants
la prematuridad.

22 wk 23 wk 24 wk 25 wk 26 wk 27 wk 28 wk
Histologic 70% 61% 59% 51% 48% 41% 34%
chorioamnionitis
Clinical 28% 26% 20% 19% 19% 15% 14%
chorioamnionitis
Early-onset sepsis 6% 4% 4% 2% 2% 2% 1%

Stoll et al Pediatrics 126: 443-456, 2010


Es5ma5ng the Probability of Neonatal Early-Onset
Infec5on on the basis of Maternal Risk Factor

} Modelo predicOvo mulOvariable (6 variables) para esOmar la


Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic

probabilidad para desarrollar sepsis neonatal precoz en


Neonates Exposed to Suspected Chorioamnionitis?
Gregory L. Jackson, William D. Engle, Dorothy M. Sendelbach, Debra A. Vedro, Sue
Josey, Jodi Vinson, Carol Bryant, Gary Hahn and Charles R. Rosenfeld
Pediatrics 2004;113;1173

neonatos 34 semanas. The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/113/5/1173.full.html

} Calculadora de riesgo de sepsis, disponible en internet.


} hfp://www.dor.kaiser.org/external/DORExternal/research/
InfecOonProbabilityCalculator.aspx PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2004 by the American Academy

Los resultados deben asociarse con la exploracin ksica y los


of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

}
datos de laboratorio, para ayudar como gua en la toma de
decisiones a la hora de iniciar tratamiento anObiOco.
Downloaded from pediatrics.aappublications.org at Hospital Virgen de la Salud Biblioteca on January 2, 2013

Puopolo et al. Pediatrics;128:1155-63. 2011


Probability of Neonatal Early-Onset Infection Based on
Maternal Risk Factors for Infants > 34 weeks gestation

Gestational age (weeks/days)


Temperature
ROM (Hours)
GBS status (positive, negative, uncertain)
Maternal intrapartum treatment (GBS specific or broad spectrum)
Was IAP given 4 hours prior to delivery

Predicted probability(/1,000 live births) =

http://www.dor.kaiser.org/external/DORExternal/research/InfectionProbabilityCalculator.aspx
Puopolo et al 2011
Probability of Neonatal Early-Onset Infection Based on
Maternal Risk Factors for Infants > 34 weeks gestation

Gestational age (weeks/days) 34 weeks 5 days


Temperature 99.5 F
ROM (Hours) 12.7 hours
GBS status (positive, negative, uncertain) Positive
Maternal intrapartum treatment GBS specific
Was IAP given 4 hours prior to delivery Yes

Predicted probability(/1,000 live births) = 0.8

http://www.dor.kaiser.org/external/DORExternal/research/InfectionProbabilityCalculator.aspx

Puopolo et al 2011
Conclusiones

Sepsis neonatal precoz causa importante de morbimortalidad


neonatal.

Los algoritmos presentados por COFN son guas orientativas,


influye el arte y la experiencia del Neonatlogo.

Los test de laboratorio son ms tiles para excluir a los recin


nacidos sin infeccin, que para identificar a los infectados.

Los antibiticos deben de suspenderse en 48-72 horas en aquellas


situaciones en las cuales la probabilidad de sepsis es baja.