Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis

In 2010, the Centers for Disease Control and Prevention in collaboration with the American Academy of Family Physicians, American Academy of Pediatrics (AAP), American College of Nurse-Midwives, American College of Obstetricians and Gynecologists, and American Society for Microbiology published revised group B streptococcal (GBS) guidelines entitled “Prevention of perinatal group B streptococcal disease: revised guidelines from CDC 2010” in the Morbidity and Mortality Weekly Report (MMWR).1 The recommendations were endorsed by all the collaborating organizations including AAP after review by the Committee on Infectious Diseases (COID) and the Committee on Fetus and Newborn (COFN) and after AAP Board approval. In the report, a revised algorithm for “Secondary prevention of early-onset group B streptococcal disease” was included. This algorithm represented the expert opinions of the technical working group (based on current literature available at that time). In 2011, the COID and the COFN published a policy statement in Pediatrics that was in agreement with the 2010 GBS guidelines and included the same algorithm.2In the spring of 2012, the COFN published a clinical report containing management guidelines entitled “Management of neonates with suspected or proven early-onset neonatal sepsis.”3 The 2012 COFN document includes guidance on laboratory evaluations and treatment duration, which were not addressed in the 2010 GBS prevention guidelines. The algorithms at the end of the COFN report differed from those in the 2010 guidelines published in the MMWR.1 The discordance in the algorithms prompted questions by the pediatric community as to which recommendations to follow.The purpose of this commentary is to clarify AAP policy. Discordant algorithms for secondary prevention of GBS were published in 2 separate policy statements.2,3 This commentary includes the algorithm that has been approved as current AAP policy. Providing a single algorithm will avoid confusion and ensure that the guidelines achieve their desired effects.The COFN and the COID strongly support the recommendations made in the 2010 prevention guidelines approved by the AAP and the other collaborating organizations (secondary prevention of GBS algorithm representing current AAP policy is attached in Fig 1). However, the COFN notes that in some situations, other approaches might be considered that differ from guidance provided in the 2010 prevention guidelines. The following recommendations include the recommendations from the 2010 MMWR publication and those made by the COFN:Published data to support recommendations for prevention and management of newborn sepsis are limited. However, success of the GBS prevention guidelines provides evidence that reductions in early-onset GBS disease have been possible by the development of consensus guidelines with consistent implementation.1 The COFN’s 2012 recommendations complement the 2010 GBS prevention guidelines by providing additional treatment information that is not addressed in the 2010 prevention guidelines. These should provide clinicians with guidance for optimal duration of antimicrobial therapy and reduce excess exposure to broad-spectrum antimicrobial therapy in healthy-appearing uninfected infants who had empirical antimicrobial therapy initiated.