Management of early-onset sepsis from a Latin American country: A survey of neonatologists management perspective

Abstract

Aim: To determine the management perspective of early-onset neonatal sepsis among neonatologists from Lima – Perú and to compare it with international society guideline recommendations. Material and Methods: We collected data from August to December 2018 from 151 neonatologists working in neonatal units in Lima-Perú with an anonymous survey. The survey contained three questions related to the participant's general characteristics and eight questions regarding the management of early-onset sepsis, including the risk factors relating to the initiation of postnatal antibiotics, the management of a low-risk febrile neonate, laboratory cutoff values, indications for a lumbar puncture, and first-line therapy and antibiotic therapy duration in culture-proven and culture-negative sepsis. Results: The mean age of the participants was 46.2 ± 8.1 years, with a median duration of clinical practice of 6 years (4.0 – 12.0). Chorioamnionitis (76.2%), maternal fever (62.3%) and prolonged rupture of the membranes (52.3%) were the most common risk factors considered for postnatal antibiotic therapy. Of the participants, 91.4% would not prescribe antibiotic therapy for a low-risk febrile neonate and would, instead, track the fever (82.8%) and do a sepsis workup (65.6%). In addition, 97.4% would do a lumbar puncture in a neonate with seizures and EOS. Only 43.1% would do a lumbar puncture in cases with a positive blood culture. Of the neonatologist, 98% defined leukopenia as a leukocyte count ≤5 × 109/L and 47.7% defined leukocytosis as a count of ≥25 × 109/L. An immature to total neutrophil ratio of ≥0.20 was used by 57.6% of them. Ampicillin/amikacin is the most common first-line drug combination for EOS, followed by ampicillin/gentamicin and ampicillin/cefotaxime. Median duration of antibiotic therapy for Gram-positive and Gram-negative organisms is 7 days (7.0 – 10.0) and 10 days (10.0 – 14.0), respectively. In culture-negative early-onset sepsis, the median antibiotic therapy duration is 7 days (5.0 – 7.0). Conclusion: There are significant differences in the approach to and management of EOS among neonatologists from Lima – Perú. A local standardized protocol would prevent this variability and minimize unnecessary procedures, antibiotic exposure, bacterial resistance, prolonged hospital stay, and mother-newborn separation.

Keywords

• Neonatal sepsis
• Early-onset sepsis