Definitions of bloodstream infection in the newborn

OBJECTIVE: To develop definitions of bloodstream infections in the newborn that would enable clinicians to identify infection early, so patients can be enrolled in clinical trials. The definitions should be useful for surveillance and epidemiologic purposes. METHOD: Search of EMBASE, MEDLINE, and Cochrane Library using age and English language limited key words sepsis, septicemia, and shock. Extensive study of textbook of neonatology and discussions with experts in the field. RESULTS: The search identified >2,000 references. The most appropriate were selected and reviewed. Definitions of bloodstream infection were developed after consultation with an international faculty. CONCLUSION: Current definitions of neonatal infection (and associated categories) used by neonatal clinicians and researchers have been either adapted/modified from definitions developed for adults or generated by individuals to suit their local needs or the needs of a particular study. It is clear that definitions generated for adults are not applicable to children or to newborn infants. In addition, developing and using unique definitions to suit individual or local needs make comparisons of outcome data and result of studies very difficult. This article proposes a set of definitions that are based as much as possible on current evidence. These definitions may be applicable widely for daily management of an infant with an infection and for research and epidemiologic studies.