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Infectious Diseases
PO-0253 Use Of Infection Markers For Diagnostic And Management Of Suspected Neonatal Early Onset Neonatal Sepsis: An International Survey
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  1. W van Herk1,
  2. S El Helou2,
  3. J Janota3,
  4. C Hagmann4,
  5. C Klingenberg5,
  6. E Staub6,
  7. E Giannoni7,
  8. S Pilgrim8,
  9. L Schlapbach9,
  10. P Tissieres10,
  11. A van Rossum1,
  12. M Stocker11
  1. 1Pediatric Infectious Diseases and Immunology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
  2. 2Division of Neonatology in the Department of Pediatrics, McMaster University, Hamilton, Canada
  3. 3Department of Neonatology, Thomayer Hospital, Prague, Czech Republic
  4. 4Division of Neonatology, University Hospital Zurich, Zurich, Switzerland
  5. 5Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway
  6. 6Pediatric Intensive Care Unit, Children’s Hospital Westmaed, Sydney, Australia
  7. 7Division of Neonatology, University Hospital of Lausanne, Lausanne, Switzerland
  8. 8Division of Neonatology, University Children’s Hospital Berne, Berne, Switzerland
  9. 9Pediatric Critical Care Research Group, Mater Children’s Hospital University of Queensland, Brisbane, Australia
  10. 10Department of Pediatric and Neonatal Intensive Care, 10) Hôpitaux Universitaires Paris-Sud AP-HPLe Kremlin-Bicêtre, Paris, France
  11. 11Division of Neonatology, Children’s Hospital Lucerne, Lucerne, Switzerland

Abstract

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.

https://doi.org/10.1136/archdischild-2014-307384.903

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