Key points Antibiotics are lifesaving and improve outcomes in neonatal clinical care. Increasing evidence in animal and human models links antibiotic exposure with alterations in the microbiome, the developing immune system, and subsequent effects on health. Empiric antibiotic use is…
Key points Herpes simplex virus (HSV) is a virus that can cause severe infection in a neonate but also has treatment options that can improve disease outcomes. There are three periods of acquisition of HSV: in utero, perinatal, and postnatal.…
Key points Congenital cytomegalovirus (CMV) is the leading infectious cause of hearing loss and neurologic deficits, affecting up to 1% of live births worldwide. Symptomatic congenital CMV infection should be treated with ganciclovir or valganciclovir for 6 months to reduce…
Key points Most early-onset infections in high-resource settings are caused by group B Streptococcus and Escherichia coli. Ampicillin + gentamicin is an appropriate empirical antibiotic regimen for early-onset sepsis in most settings. Most late-onset infections are caused by Gram-positive organisms.…
Key points The current incidence of neonatal early-onset sepsis (EOS) among infants born ≥37 weeks is relatively low (≈1/2000) and as much as 20-fold lower among well-appearing term infants. There are three major approaches to EOS risk assessment among term…
Introduction The onset of necrotizing enterocolitis (NEC) is associated with decreased platelet counts in most patients within 24 hours, and the severity of this thrombocytopenia (defined as platelet counts <150 × 10 9 /L) typically correlates with the severity and…
Introduction Fresh frozen plasma (FFP) is the most commonly used hemostatic agent in neonatal intensive care units (NICUs), especially among critically ill neonates and for those who need extracorporeal life support (ECLS). Current guidelines on FFP administration in neonates are…
Introduction The underlying reasons for bleeding are multifactorial and likely include a combination of hematologic (i.e., platelet, von Willebrand factor [vWF], coagulation factors) and environmental factors such as vessel wall integrity, inflammation, and hemodynamic status. However, it is unknown to…
Introduction Thrombocytopenia (defined as a platelet count <150 × 10 9 /L) is the second most common hematologic problem among neonates admitted to the neonatal intensive care unit (NICU), affecting 20% to 25% of this patient population. The incidence of…
Introduction Blood component transfusion is critical to modern neonatal medicine to support oxygen delivery, cardiac output, and maintain hemostasis, especially in the context of preventing bleeding or treating the bleeding neonate. Of all admissions to the neonatal intensive care unit…