Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.25754/pjp.2022.25768 |
Resumo: | Introduction: Identification of well-appearing infants at risk for early-onset sepsis presents an ongoing challenge. Several guidelines advise categorical risk assessment strategies, resulting in excessive laboratory tests, admissions, and antibiotic use. Currently, approaches using multivariate risk assessment or serial clinical observation are gaining ground. The primary objective of this study was to describe early-onset-sepsis risk management across a national sample of postnatal wards. Methods: A Web-based survey was sent to 51 neonatal units in Portugal, between April and June 2021, to assess local management protocol for term and near-term newborns at risk for early-onset sepsis. Results: Thirty-four responses were obtained (out of a total of 65 161 deliveries in 2020). Sociedade Portuguesa de Neonatologia guidelines were followed in 17 out of 34 units. Most units (31/34) used categorical risk assessment and three used serial clinical observation. The considered risk factors differed and the most frequently identified included chorioamnionitis (33/34) and prolonged rupture of membranes (31/34). The most frequent timing for sepsis evaluation was between 6 and 12 hours of life and included blood count and C-reactive protein in all units. Most units (29/33) opted for empiric antibiotics, according to clinical assessment and C-reactive protein values. Antibiotic therapy is started in all cases of chorioamnionitis in 12 out of 34 units. Asymptomatic infants with negative cultures are treated for five or more days in 16 out of 34 units, and in 22 units this is done in the neonatal unit. The majority (25/34) considers possible to adopt a serial clinical evaluation approach. Main concerns were local staff resources (16/24). Discussion: There is wide variability regarding early-onset-sepsis risk assessment in Portugal. Therefore, it is crucial to standardize clinical pathways to avoid unnecessary interventions. |
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Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in PortugalOriginal articlesIntroduction: Identification of well-appearing infants at risk for early-onset sepsis presents an ongoing challenge. Several guidelines advise categorical risk assessment strategies, resulting in excessive laboratory tests, admissions, and antibiotic use. Currently, approaches using multivariate risk assessment or serial clinical observation are gaining ground. The primary objective of this study was to describe early-onset-sepsis risk management across a national sample of postnatal wards. Methods: A Web-based survey was sent to 51 neonatal units in Portugal, between April and June 2021, to assess local management protocol for term and near-term newborns at risk for early-onset sepsis. Results: Thirty-four responses were obtained (out of a total of 65 161 deliveries in 2020). Sociedade Portuguesa de Neonatologia guidelines were followed in 17 out of 34 units. Most units (31/34) used categorical risk assessment and three used serial clinical observation. The considered risk factors differed and the most frequently identified included chorioamnionitis (33/34) and prolonged rupture of membranes (31/34). The most frequent timing for sepsis evaluation was between 6 and 12 hours of life and included blood count and C-reactive protein in all units. Most units (29/33) opted for empiric antibiotics, according to clinical assessment and C-reactive protein values. Antibiotic therapy is started in all cases of chorioamnionitis in 12 out of 34 units. Asymptomatic infants with negative cultures are treated for five or more days in 16 out of 34 units, and in 22 units this is done in the neonatal unit. The majority (25/34) considers possible to adopt a serial clinical evaluation approach. Main concerns were local staff resources (16/24). Discussion: There is wide variability regarding early-onset-sepsis risk assessment in Portugal. Therefore, it is crucial to standardize clinical pathways to avoid unnecessary interventions.Introdução A abordagem do recém-nascido em risco de sepsis precoce, baseada na avaliação categórica de fatores de risco, resulta num número excessivo de internamentos, avaliações laboratoriais e antibioticoterapia. A calculadora de risco de sepsis e a observação clínica seriada têm sido aplicadas crescentemente com evidência de segurança e eficácia. O principal objectivo deste estudo foi caracterizar a abordagem nacional para a avaliação de risco de sepsis precoce em recém-nascidos assintomáticos com idade gestacional maior ou igual a 35 semanas. Métodos Foi enviado um questionário a 51 Unidades de Apoio Perinatal Portuguesas entre Abril e Junho de 2021. Resultados Obtiveram-se 34 respostas (65161 partos em 2020). Dezassete unidades seguem os Consensos 2014 da Sociedade Portuguesa de Neonatologia. A maioria (31/34) utiliza abordagens baseadas na avaliação categórica de fatores de risco e três utilizam estratégias baseadas na observação clínica seriada. Os fatores de risco mais utilizados são a corioamnionite e a rotura prolongada de membranas. O rastreio séptico é realizado mais frequentemente (18/34) entre as 6 e as 12 horas de vida e inclui hemograma e proteína-C-reactiva em todos. Na maioria (29/34) a instituição de antibioticoterapia baseia-se na clínica e valor seriado da proteína-C-reactiva. Doze unidades instituem antibioticoterapia na presença de corioamnionite independentemente do rastreio séptico. A duração de antibioticoterapia em recém-nascidos assintomáticos e com hemocultura negativa é de cinco ou mais dias em 16/34 e em 22 isto implica internamento na unidade. A maioria (25/34) considera aplicável uma estratégia baseada na observação clínica seriada, sendo o principal obstáculo identificado os recursos humanos (16/34). Discussão Existe grande variabilidade nacional na abordagem do risco infecioso neonatal. É fundamental rever aplicabilidade de estratégias que minimizam intervenções desnecessárias, uma vez que estas afetam um grande número de recém-nascidos.Sociedade Portuguesa de Pediatria2022-10-03info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://doi.org/10.25754/pjp.2022.25768eng2184-44532184-3333Sampaio, IsabelDuarte, CatarinaGirbal, InêsGouveia, Raquelinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-08-03T02:58:23Zoai:ojs.revistas.rcaap.pt:article/25768Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:25:39.990945Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal |
title |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal |
spellingShingle |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal Sampaio, Isabel Original articles |
title_short |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal |
title_full |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal |
title_fullStr |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal |
title_full_unstemmed |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal |
title_sort |
Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal |
author |
Sampaio, Isabel |
author_facet |
Sampaio, Isabel Duarte, Catarina Girbal, Inês Gouveia, Raquel |
author_role |
author |
author2 |
Duarte, Catarina Girbal, Inês Gouveia, Raquel |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Sampaio, Isabel Duarte, Catarina Girbal, Inês Gouveia, Raquel |
dc.subject.por.fl_str_mv |
Original articles |
topic |
Original articles |
description |
Introduction: Identification of well-appearing infants at risk for early-onset sepsis presents an ongoing challenge. Several guidelines advise categorical risk assessment strategies, resulting in excessive laboratory tests, admissions, and antibiotic use. Currently, approaches using multivariate risk assessment or serial clinical observation are gaining ground. The primary objective of this study was to describe early-onset-sepsis risk management across a national sample of postnatal wards. Methods: A Web-based survey was sent to 51 neonatal units in Portugal, between April and June 2021, to assess local management protocol for term and near-term newborns at risk for early-onset sepsis. Results: Thirty-four responses were obtained (out of a total of 65 161 deliveries in 2020). Sociedade Portuguesa de Neonatologia guidelines were followed in 17 out of 34 units. Most units (31/34) used categorical risk assessment and three used serial clinical observation. The considered risk factors differed and the most frequently identified included chorioamnionitis (33/34) and prolonged rupture of membranes (31/34). The most frequent timing for sepsis evaluation was between 6 and 12 hours of life and included blood count and C-reactive protein in all units. Most units (29/33) opted for empiric antibiotics, according to clinical assessment and C-reactive protein values. Antibiotic therapy is started in all cases of chorioamnionitis in 12 out of 34 units. Asymptomatic infants with negative cultures are treated for five or more days in 16 out of 34 units, and in 22 units this is done in the neonatal unit. The majority (25/34) considers possible to adopt a serial clinical evaluation approach. Main concerns were local staff resources (16/24). Discussion: There is wide variability regarding early-onset-sepsis risk assessment in Portugal. Therefore, it is crucial to standardize clinical pathways to avoid unnecessary interventions. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-10-03 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.25754/pjp.2022.25768 |
url |
https://doi.org/10.25754/pjp.2022.25768 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
2184-4453 2184-3333 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Pediatria |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Pediatria |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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