Background Early diagnosis and treatment of neonatal early-onset sepsis (EOS) is essential to prevent severe and life threatening complications. Diagnosis is difficult because of the variable and nonspecific clinical presentation.
Aim To determine the use of laboratory investigations for the decision to start/stop antibiotic therapy and to determine the duration of empiric therapy in infection risk adjusted scenarios.
Methods Web-based questionnaire (Survey monkey®), developed by the NEonatal Sepsis Trial NETwork (http://www.nest-net.org), was sent to neonatologists worldwide. Questions regarding management (n = 7) were introduced by scenarios levelled to low-, medium- and high risk for neonatal EOS. Demographic questions (n = 4) are based on competency, caseload, experience of fatal cases (deaths) and country of origin.
Results 439 Neonatologist from 10 countries participated. Laboratory investigations are used in 31% to start, and in 72% to stop antibiotic treatment. The decision regarding stop of antibiotic therapy is mainly dependent on conventional laboratory investigations. Only a minority uses newer infection markers as procalcitonin (17%) or interleukins (9%). There is a high variance in when to start and when to stop antibiotic therapy with a national distribution. Variance is lower within one country compared to the variance in all participating countries. There is no dependency on other demographic variables.
Conclusions There is a high variance in the management of neonatal EOS. Discontinuation has a high dependency on laboratory infection markers. Clinical research should focus on safety and predictive values of (new) infection markers to support the decision to stop antibiotic therapy early and prevent possibly unnecessary antibiotic treatment.