Commentary
Reappraisal of Guidelines for Management of Neonates with Suspected Early-Onset Sepsis

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The Evolution of Neonatal Sepsis Risk Assessment

Adoption of intrapartum antibiotic prophylaxis for the prevention of early-onset group B streptococcal (GBS) sepsis since 1995 has resulted in an 85% reduction in the rate of culture-proven early-onset GBS sepsis, from approximately 1.8 per 1000 live births in the early 1990s21 to fewer than 0.25 per 1000 live births22 since 2010. Comparable data for EOS of all causes also reflect a reduction in attack rate, from 2.0 to 2.5 in the late 1980s and 1990s23, 24, 25 to 0.8 to 1.0 per 1000 live

Conclusions

The changing environment and new data require reappraisal of traditional approaches to management of infants at risk for sepsis, with willingness to question and abandon, if necessary, long-held assumptions. Neither identification of maternal risk factors nor screening using laboratory testing is an effective strategy for the ascertainment of infants with EOS in the current era. Recommendation of such approaches in current CDC and AAP recommendations should not prohibit development and adoption

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      There is currently no agreed-upon definition of neonatal sepsis for low- and middle-income countries (LMICs)4 and broadly includes pneumonia, sepsis, meningitis, arthritis, osteomyelitis and urinary tract infections.5 Due to limited blood culture-testing facilities in most secondary hospitals of India and the non-specific features of clinical sepsis, quick and accurate identification of neonates with early onset of sepsis (EOS) is often a huge challenge.6 Moreover, the culture testing results usually take around 48 h and are liable for many false-positive results after antenatal antibiotic exposure.7

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    J.W. is supported by the National Institutes of Health/National Institute of General Medical Sciences (GM106143). The authors declare no conflicts of interest.

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