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Utility of intramuscular antibiotics for secondary prevention of early onset, asymptomatic ‘suspected’ neonatal sepsis

Journal of Perinatology volume 32, pages 454–459 (2012)Cite this article

Abstract

Objective:

To evaluate the safety, efficacy and cost–benefit of intramuscular (IM) antibiotics administration in the secondary prevention of suspected neonatal sepsis in asymptomatic term neonates.

Study Design:

Retrospective review of inborn asymptomatic full-term neonates with birth weights ⩾2000 g who required sepsis evaluation and treatment with IM antibiotics were undertaken from July 2001 to July 2008. The IM antibiotic protocol was categorized as inadequate if the neonate became symptomatic, had positive blood or cerebrospinal fluid (CSF) cultures or was readmitted for sepsis within 2 weeks of nursery discharge. Data were analyzed to identify relationships between key indicators for the presence of neonatal bacterial infection, ‘inadequate IM antibiotics protocol’ and the rehospitalization rates.

Result:

There were 29 698 infants admitted to the newborn nursery (NBN) during the study period. A total of 5045 infants (17%) were evaluated for suspected neonatal sepsis; 421 neonates (8.3%) were treated with IM antibiotics for 48 to 72 h. Fourteen infants (3.3%) met criteria for ‘inadequate IM antibiotics protocol’. Seven infants developed symptoms within the first 32 h of life, and seven infants had positive blood or CSF cultures, one of whom required rehospitalization. None of the infants were hemodynamically unstable or developed complications, including adverse events associated with IM drug administration.

Conclusion:

Use of IM antibiotics is a safe alternative to intravenous antibiotics in the secondary prevention of asymptomatic term newborns with presumed sepsis. There is a substantial cost savings in caring for asymptomatic neonates with presumed sepsis in the NBN compared with neonatal intensive care unit costs.

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References

  1. Spitzer AR, Kirkby S, Kornhauser M . Practice variation in suspected neonatal sepsis: a costly problem in neonatal intensive care. J of Perinat 2005; 25: 265–269.

    Article  Google Scholar 

  2. Escobar GJ, Li D-K, Armstrong MA, Gardner MN, Folck BF, Verdi JE et al. Neonatal sepsis workups in infants >2000 grams at birth: a population-based study. Pediatrics 2000; 106 (2): 256–263.

    Article  CAS  Google Scholar 

  3. CDC. Trends in perinatal group B streptococcal disease - United States, 2000-2006. MMWR 2009; 58 (5): 109–112.

    Google Scholar 

  4. CDC. Prevention of perinatal group B streptococcal disease-revised guidelines from CDC, 2010. MMWR 2010; 59 (No RR-10): 1–32.

    Google Scholar 

  5. Schrag SJ, Stoll BJ . Early onset neonatal sepsis in an era of widespread intrapartum chemoprophylaxis. Pediatr Infect Dis J 2006; 25 (10): 939–940.

    Article  Google Scholar 

  6. Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S et al. Epidemiology of invasive group B streptococcal disease in the US, 1999–2005. JAMA 2008; 299 (17): 2056–2065.

    Article  CAS  Google Scholar 

  7. Van Dyke MK, Phares CR, Lynfield R, Thomas AR, Arnold KE, Schrag SJ et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 2009; 360 (25): 2626–2636.

    Article  CAS  Google Scholar 

  8. CDC. Perinatal group B streptococcal disease after universal screening recommendations–United States, 2003–2005. MMWR 2007; 56: 701–705.

    Google Scholar 

  9. Kuhn P, Dheu C, Bolender C, Chognot D, Keller L, Demil H . Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics. Paediatr Perinat Epidemiol 2010; 24 (5): 479–487.

    Article  Google Scholar 

  10. CDC. Prevention of perinatal group B streptococcal disease, revised guidelines from CDC. MMWR 2002; 51 (RR11): 1–22.

    Google Scholar 

  11. Wiswell TE, Stoll BJ, Tuggle JM . Management of the asymptomatic, term gestation neonates born to mothers treated with intrapartum antibiotics. Pediatr Infect Dis J 1990; 9 (11): 826–831.

    Article  CAS  Google Scholar 

  12. Manroe BL, Weinberg AG, Rosenfeld CR, Browne R . The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979; 95 (1): 89–98.

    Article  CAS  Google Scholar 

  13. Merrill C, Steiner C . Hospitalizations Related to Childbirth, 2003. HCUP Statistical Brief #11. August 2006 Agency for Healthcare Research and Quality: Rockville, MD URL: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb11.pdf.

  14. Verani J, Schrag SJ . Group B. streptococcal disease in infants: progress in prevention and continuing challenges. Clin Perinatol 2010; 37 (2): 375–392.

    Article  Google Scholar 

  15. Benitz WE, Han MY, Madan A, Ramachandran P . Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998; 102 (4): e41.

    Article  CAS  Google Scholar 

  16. Jackson GL, Engle WD, Sendelbach DM, Vedro DA, Josey S, Vinson J et al. Are complete blood counts useful in the evaluation of asymptomatic neonates exposed to suspected chorio-amnionitis. Pediatrics 2004; 113 (5): 1173–1180.

    Article  Google Scholar 

  17. Ng PC . Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal Ed 2004; 89: F229–F235.

    Article  CAS  Google Scholar 

  18. De Hoog M, Mouton J, van den Anker JN . The use of aminoglycosides in newborns. Paed Perinatal Drug Ther 1998; 2: 48–56.

    CAS  Google Scholar 

  19. Hayani KC, Hatzopoulos FK, Frank AL, Thummala MR, Hantsc MJ, Schatz BM et al. Pharmacokinetics of once daily dosing in neonates. J Pediatr 1997; 131: 76–80.

    Article  CAS  Google Scholar 

  20. Paisley JW, Smith AL . Gentamicin in newborn infants. Comparison of intramuscular and intravenous administration. Am J Dis Child 1973; 126 (4): 473–477.

    Article  CAS  Google Scholar 

  21. Thomson AH, Kokwaro GO, Muchohi SN, English M, Mohammed S, Edwards G . Population pharmacokinetics of intramuscular gentamicin administered to young infants with suspected severe sepsis in Kenya. Br J Clin Pharmacol 2003; 56: 25–31.

    Article  CAS  Google Scholar 

  22. Blumer JL, Reed MD . Principles of neonatal pharmacology. In: Yaffe SJ, Aranda JV (eds). Neonatal and Pediatric Pharmacology: Therapeutic Principles in Practice. 3rd edn Lippincott Williams & Wilkins: Philadelphia, PA, 2005, pp 150.

    Google Scholar 

  23. Wahlgren CF, Quiding H . Depth of cutaneous analgesia after application of a eutectic mixture of the local anesthetics lidocaine and prilocaine (EMLA cream). Am Acad Dermatol 2000; 42 (4): 584–588.

    Article  CAS  Google Scholar 

  24. Schulman M . Neonatology and emerging trends in health insurance. Am J Perinatol 2003; 20 (8): 433–439.

    Article  Google Scholar 

  25. Richardson DK, Zupancic JA, Escobar GJ, Ogino M, Pursley DM, Mugford M . A critical review of cost reduction in neonatal intensive care. II. Strategies for reduction. J Perinatol 2001; 21 (2): 121–127.

    Article  CAS  Google Scholar 

  26. Richardson DK, Zupancic JA, Escobar GJ, Ogino M, Pursley DM, Mugford M . A critical review of cost reduction in neonatal intensive care. I. The structure of costs. J Perinatol 2001; 21 (2): 107–115.

    Article  CAS  Google Scholar 

  27. HCUP Net: a tool for identifying, tracking and analyzing national hospital statistics URL: http://hcupnet.ahrq.gov.

  28. Owens PL, Thompson J, Elixhauser A, Ryan K . Care of Children and Adolescents in US Hospitals. Agency for Healthcare Research and Quality: Rockville (MD), 2003 HCUP Fact Book No. 4; AHRQ Publication No. 04-0004. ISBN 1-58763-137-7. URL: http://www.ahrq.gov/data/hcup/factbk4/factbk4.pdf.

    Google Scholar 

  29. HCUP Net: a tool for identifying, tracking and analyzing national hospital statistics URL: http://hcupnet.ahrq.gov.

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Author information

Authors and Affiliations

  1. Princess Margaret Hospital, Goodwill, Commonwealth of Dominica, West Indies

    B Lambert

  2. Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA

    S M Nafday & D E Campbell

  3. Pediatric resident, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

    K Woodrooffe

  4. Division of Biostatistics, Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    M Kim

Authors
  1. B Lambert
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  2. S M Nafday
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  3. D E Campbell
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  4. K Woodrooffe
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  5. M Kim
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Correspondence to S M Nafday.

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The authors declare no conflict of interest.

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All authors have made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data. They also participated in drafting the article or revising it critically for important intellectual content; and have reviewed the final approval of the version to be published. All authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

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Lambert, B., Nafday, S., Campbell, D. et al. Utility of intramuscular antibiotics for secondary prevention of early onset, asymptomatic ‘suspected’ neonatal sepsis. J Perinatol 32, 454–459 (2012). https://doi.org/10.1038/jp.2011.126

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  • DOI: https://doi.org/10.1038/jp.2011.126

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