The American Academy of Pediatrics (AAP) issues guidance for managing an asymptomatic infant < 37 weeks of gestation born to a mother with risk factors for neonatal sepsis. The goal is to provide or discontinue antibiotic therapy based on need.
Parameters: asymptomatic neonate < 37 weeks of gestation AND risk factors for neonatal sepsis (maternal chorioamnionitis, rupture of membranes >= 18 hours, inadequate intrapartum antibiotic prophylaxis)
Initial management:
(1) Blood cultures are collected from the neonate at birth.
(2) Broad spectrum antibiotics (ampicillin and aminoglycoside, or altnerative) are started after blood cultures are collected.
(2) A WBC with differential and CRP are collected 6-12 hours after birth.
Blood Cultures
Clinical Status
Lab Data
Management
Positive
NA
NA
Continue antibiotics, perform lumbar puncture.
NA
Symptomatic
NA
Continue antibiotics, perform lumbar puncture.
Negative
Asymptomatic
Abnormal
Continue antibiotics if mother received intrapartum antibiotics.
Negative
Asymptomatic
Normal
Discontinue antibiotics, discharge when infant meets discharge criteria.
where:
• If antibiotics are given because of abnormal laboratory tests and maternal intrapartum antibiotics, then discontinue at 48 hours if probablility of sepsis is low.
• If laboratory tests are abnormal but the mother did not get intrapartum antibiotics then management depends on monitoring the infant.
• The diagnosis of chorioamnionitis can be subjective and may require discussion with the obstetrician.
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