Management of the asymptomatic newborn at risk for sepsis

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 infants: categorical consideration of risk factors, multivariate consideration of risk factors in combination with clinical condition, and consideration of the clinical condition alone as it evolves in the first 48 hours after birth.

• Currently available laboratory tests lack sensitivity for predicting culture-confirmed EOS among term infants.

• EOS-associated clinical activities may have a significant impact on early mother–newborn interactions and initiation of breastfeeding.

• Depending on the local structure of care, EOS risk assessment activities are costly in terms of caregiver time, resource allocation, and monetary expenditures.

• Preclinical animal and clinical human studies demonstrate an impact of perinatally administered antibiotics on the initial composition of the newborn gut microbiome.

• Retrospective human epidemiologic studies associate perinatal and early infancy antibiotics with multiple morbidities in early childhood.