Stocker et al reported a model for duration of antibiotic therapy in a neonate with suspected early-onset sepsis. This can reduce the duration of antibiotic therapy and was superior to standard care. The authors participated in the Neonatal Procalcitonin Intervention Study (NeoPlns) trial.
Patient selection: neonate with suspected early-onset sepsis, > 34 weeks gestational age
Exclusion: congenital malformation, lack of parenteral consent, surgery in first week of lfe)
Parameters:
(1) risk factors
(2) clinical symptoms
(3) non-culture laboratory features
(4) culture
Risk factors:
(1) maternal Group B Streptococcus positive
(2) maternal chorioamnionitis (fever > 38.5°C, tachycardia)
(3) premature rupture of membranes > 18 hours
(4) gestational age < 37 weeks
Clinical symptoms:
(1) respiratory distress or apnea
(2) bradycardia or tachycardia
(3) arterial hypotension and/or poor perfusion
(4) hypothermia or hyperthermia
(5) seizures, floppy infant, irritability or lethargy
(6) vomiting, feeding intolerance, or ileus
Non-culture laboratory findings:
(1) WBC count < 5 * 10^9/L
(2) serum CRP > 10 mg/L
|
Parameter
|
Finding
|
Points
|
|
risk factors
|
none present
|
0
|
|
|
one or more present
|
1
|
|
clinical symptoms
|
none present
|
0
|
|
|
one or more present
|
1
|
|
non-culture lab findings
|
neither
|
0
|
|
|
1 or both
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
|
Culture Result
|
Total Score
|
Category
|
|
negative
|
0 or 1
|
4 (low risk, infection unlikely)
|
|
negative
|
2
|
3 (medium risk, infection possible)
|
|
negative
|
3
|
2 (high risk, infection probable)
|
|
positive
|
>= 1
|
1 (proven infection)
|
where:
• There was no option for positive culture and 0 total score.
|
Category
|
Standard Duration
|
Using Serum Procalcitonin
|
|
1
|
36-72 hours
|
at least 24 hours; stop after 2 consecutive values <= ULN (below)
|
|
2
|
5-7 days
|
at least 24 hours; stop after 2 consecutive values <= ULN (below)
|
|
3
|
7-21 days
|
NA
|
|
4
|
7-21 days
|
NA
|
|
Time After Birth
|
Upper Limit of Normal
|
|
0 to 6 hours
|
0.5 ng/mL
|
|
6 to 12 hours
|
2.0 ng/mL
|
|
12 to 18 hours
|
5 ng/mL
|
|
18 to 36 hours
|
10 ng/mL
|
|
36 to 48 hours
|
5 ng/mL
|
|
48 to 60 hours
|
2 ng/mL
|
|
60 to 72 hours
|
1 ng/mL
|
|
72 to 96 hours
|
0.5 ng/mL
|
