Problemi speciali
La gestione del nato a rischio di infezione precoce
Management of the newborn at risk of early-onset sepsis
Alberto Berardi1, Isotta Guidotti1, Giulia Vellani1, Cecilia Rossi1, Licia Lugli1, Roberta Creti2, Sara Fornaciari1, Viviana Patianna1, Fabrizio Ferrari1
1Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria, Policlinico, Modena
2Unità per le Malattie Batteriche Sistemiche e Respiratorie, Dipartimento MIPI, Istituto Superiore di Sanità, Roma
Ottobre 2013 - pagg. 507 -513
Abstract
The management of neonates at risk of early-onset sepsis is a challenge. In the last years,
the approach has been based on laboratory tests that have been proven to be low predictive.
Recent Italian data suggest that a less invasive approach, based on careful physical
examination, may replace testing. Starting from 2009 in Emilia Romagna (Italy)
asymptomatic neonates at risk of early-onset sepsis do not undergo sepsis workup. Clinicians
and nurses in turn fill in and sign a standardized form (detailing general wellbeing,
skin colour including perfusion, and the presence of respiratory signs) at close intervals.
At-risk neonates are diagnosed in a timely manner through this strategy.
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Bibliografia
1. Palazzi D, Klein J, Baker C. Bacterial sepsis
and meningitis. In: Remington J, Klein J, Wilson
C, Baker C (Eds). Infectious diseases of
the fetus and newborn infant, 6th ed. Philadelphia:
Elsevier Saunders 2006:247-95.
2. Mukhopadhyay S, Puopolo KM. Risk assessment
in neonatal early onset sepsis. Semin
Perinatol 2012,36:408-15.
3. Gerdes JS. Clinicopathologic approach to
the diagnosis of neonatal sepsis. Clin Perinatol
1991;18:361-81.
4. Ganatra HA, Stoll BJ, Zaidi AK. International
perspective on early-onset neonatal sepsis.
Clin Perinatol 2010;37:501-23.
5. Berardi A, Lugli L, Rossi C, et al. La rete di
sorveglianza delle infezioni da Streptococco B
nella regione Emilia-Romagna: prevenzione
delle infezioni precoci. Quaderni acp 2010;
17:3-7.
6. CDC. Prevention of perinatal group B streptococcal
disease: Revised guidelines from
CDC. MMWR 2002;51:1-22.
7. Stoll BJ, Hansen N, Fanaroff AA, et al. Changes
in pathogens causing early-onset sepsis in
very-low-birth-weight infants. N Engl J Med
2002;347:240-7.
8. Berardi A, Mariotti I, Pagano R, et al. Lo
shock settico in età pediatrica. Medico e Bambino
2006;25:289-97.
9. Berardi A, Lugli L, Baronciani D, et al. GBS
Prevention Working Group of Emilia-Romagna.
Group B Streptococcus early-onset disease
in Emilia-Romagna: review after introduction
of a screening-based approach. Pediatr Infect
Dis J 2010;29:115-21.
10. Royal College of Obstetricians and Gynaecologists.
Guidelines. Prevention of early onset
neonatal group B streptococcal disease.
Guideline 2003;36:1-10. http://www.rcog. org.
uk/resources/Public/pdf/GroupB_strep_ no
36.pdf.
11. Prevention of perinatal group B streptococcal
disease: a public health perspective.
MMWR Recomm Rep 1996;45:1-24.
12. Verani JR, McGee L, Schrag SJ. Division
of Bacterial Diseases, National Center for Immunization
and Respiratory Diseases, Centres
for Disease Control and Prevention
(CDC). Prevention of perinatal group B streptococcal
disease - revised guidelines from
CDC, 2010. MMWR Recomm Rep 2010;59
(RR-10):1-36.
13. Berardi A, Lugli L, Rossi C, et al. Intrapartum
antibiotic prophylaxis failure and group-B
Streptococcus early-onset disease. J Matern Fetal
Neonatal Med 2011;24:1221-4.
14. Berardi A, Rossi C, Biasini A, et al. Efficacy
of intrapartum chemoprophylaxis less than 4
hours duration. J Matern Fetal Neonatal Med
2011;24:619-25.
15. Illuzzi JL, Bracken MB. Duration of intrapartum
prophylaxis for neonatal group B
streptococcal disease: a systematic review.
Obstet Gynecol 2006;108:1254-65.
16. Benitz WE. Adjunct laboratory tests in the
diagnosis of early-onset neonatal sepsis. Clin
Perinatol 2010;37:421-38.
17. Bloom SL, Cox SM, Bawdon RE, et al. Ampicillin
for neonatal group B streptococcal
prophylaxis: how rapidly can bactericidal concentrations
be achieved? Am J Obstet Gynecol
1996;175:974-6.
18. Barber EL, Zhao G, Buhimschi IA, et al.
Duration of intrapartum prophylaxis and concentration
of penicillin G in fetal serum at delivery.
Obstet Gynecol 2008;112:265-70.
19. Kellogg JA, Ferrentino FL, Goodstein MH,
et al. Frequency of low level bacteremia in infants
from birth to two months of age. Pediatr
Infect Dis J 1997;16:381-5.
20. Fischer JE, Seifarth FG, Baenziger O, et
al. Hindsight judgment on ambiguous episodes
of suspected infection in critically ill children.
Eur J Pediatr 2003;162:840-3.
21. Polin RA; Committee on Fetus and Newborn.
Management of neonates with suspected
or proven early-onset bacterial sepsis. Pediatrics
2012;129:1006-15.
22. Squire E, Favara B, Todd J. Diagnosis of
neonatal bacterial infection: hematologic and
pathologic findings in fatal and nonfatal cases.
Pediatrics 1979;64:60-4.
23. Eisenfeld L, Ermocilla R, Wirtschafter D,
et al. Systemic bacterial infections in neonatal
deaths. Am J Dis Child 1983;137:645-9.
24. Pierce JR, Merenstein GB, Stocker JT. Immediate
postmortem cultures in an intensive
care nursery. Pediatr Infect Dis 1984;3:510-3.
25. Ottolini MC, Lundgren K, Mirkinson LJ,
et al. Utility of complete blood count and blood
culture screening to diagnose neonatal sepsis
in the asymptomatic at risk newborn. Pediatr
Infect Dis J 2003;22:430-4.
26. Kumar Y, Qunibi M, Neal TJ, Yoxall CW.
Time to positivity of neonatal blood cultures.
Arch Dis Child Fetal Neonatal Ed 2001;85:
F182-6.
27. Garcia-Prats JA, Cooper TR, Schneider VF,
Stager CE, Hansen TN. Rapid detection of microorganisms
in blood cultures of newborn infants
utilizing an automated blood culture system.
Pediatrics 2000;105:523-7.
28. Berardi A, Lugli L, Rossi C, et al. Neonatal
bacterial meningitis. Minerva Pediatr 2010;62
(S1):51-4.
29. Garges HP, Moody MA, Cotten CM, et al.
Neonatal meningitis: what is the correlation
among cerebrospinal fluid cultures, blood cultures,
and cerebrospinal fluid parameters? Pediatrics
2006;117:1094-100.
30. Kanegaye JT, Soliemanzadeh P, Bradley
JS. Lumbar puncture in pediatric bacterial meningitis:
defining the time interval for recovery
of cerebrospinal fluid pathogens after parenteral
antibiotic pretreatment. Pediatrics
2001;108:1169-74.
31. Engle WD, Rosenfeld CR. Neutropenia in
high-risk neonates. J Pediatr 1984;105:982-6.
32. Christensen RD, Rothstein G, Hill HR, Hall
RT. Fatal early onset group B streptococcal sepsis
with normal leukocyte counts. Pediatr Infect
Dis 1985;4:242-5.
33. Manroe BL, Weinberg AG, Rosenfeld CR,
Browne R. The neonatal blood count in health
and disease. I. Reference values for neutrophilic
cells. J Pediatr 1979;95:89-98.
34. Newman TB, Puopolo KM, Wi S, Draper
D, Escobar GJ. Interpreting complete blood
counts soon after birth in newborns at risk for
sepsis. Pediatrics 2010;126:903-9.
35. Hornik CP, Benjamin DK, Becker KC, et
al. Use of the complete blood cell count in
early-onset neonatal sepsis. Pediatr Infect Dis
J 2012;31:799-802.
36. Mathai E, Christopher U, Mathai M, et al.
Is C-reactive protein level useful in differentiating
infected from uninfected neonates
among those at risk of infection? Indian Pediatr
2004;41:895-900.
37. Chiesa C, Osborn JF, Pacifico L, Natale F,
De Curtis M. Gestational- and age-specific
CRP reference intervals in the newborn. Clin
Chim Acta 2011;412:1889-90.
38. Kääpä P, Koistinen E. Maternal and neonatal
C-reactive protein after interventions during
delivery. Acta Obstet Gynecol Scand
1993;72:543-6.
39. Ishibashi M, Takemura Y, Ishida H, Watanabe
K, Kawai T. C-Reactive Protein Kinetics
in Newborns: Application of a High-Sensitivity
Analytic Method in Its Determination. Clin
Chem 2002;48:1103-6.
40. Hofer N, Zacharias E, Müller W, Resch B.
An update on the use of C-reactive protein in
early-onset neonatal sepsis: current insights
and new tasks. Neonatology 2012;102:25-36.
41. Kukkonen AK, Virtanen M, Järvenpää AL,
Pokela ML, Ikonen S, Fellman V. Randomized
trial comparing natural and synthetic surfactant:
increased infection rate after natural surfactant?
Acta Paediatr 2000;89:556-61.
42. American Academy of Pediatrics. Red
Book: 2012 Report of the Committee on Infectious
Diseases. Pickering LK (Ed), 29th ed.
Elk Grove Village, IL: American Academy of
Pediatrics, 2012.
43. Benitz WE, Han MY, Madan A, et al. Serial
serum C-reactive protein levels in the diagnosis
of neonatal infection. Pediatrics 1998;102: E41.
44. Pourcyrous M, Bada HS, Korones SB, et al.
Significance of serial C-reactive protein responses
in neonatal infection and other disorders.
Pediatrics 1993;92:431-5.
45. Philip AG. Response of C-reactive protein
in neonatal Group B streptococcal infection.
Pediatr Infect Dis 1985;4:145-8.
46. Chiesa C, Pellegrini G, Panero A, et al. Creactive
protein, interleukin-6, and procalcitonin
in the immediate postnatal period: influence
of illness severity, risk status, antenatal
and perinatal complications, and infection.
Clin Chem 2003;49:60-8.
47. Stocker M, Fontana M, El Helou S, et al.
Use of procalcitonin-guided decision-making to
shorten antibiotic therapy in suspected neonatal
early-onset sepsis: Prospective randomized
intervention trial. Neonatology 2010;97: 165-74.
48. Haque KN. In: McIntosh N, Stenson B
(Eds). Textbook of Paediatrics. Sixth Edition,
Edinburgh: Livingston, 2003.
49. Rodwell RL, Leslie AL, Tudehope DI. Early
diagnosis of neonatal sepsis using a hematologic
scoring system. J Pediatr 1988;112:761-7.
50. Celik IH, Demirel FG, Uras N, et al. What
are the cut-off levels for IL-6 and CRP in neonatal
sepsis? J Clin Lab Anal 2010;24:407-12.
51. Doellner H, Arntzen KJ, Haereid PE, Aag
S, Austgulen R. Interleukin-6 concentrations
in neonates evaluated for sepsis. J Pediatr
1998;132:295-9.
52. Franz AR, Steinbach G, Kron M, Pohlandt
F. Interleukin-8: a valuable tool to restrict antibiotic
therapy in newborn infants. Acta Paediatr
2001;90:1025-32.
53. Laborada G, Rego M, Jain A, et al. Diagnostic
value of cytokines and C-reactive protein
in the first 24 h of neonatal sepsis. Am J Perinatol 2003;20:491-501.
54. Edgar JD, Gabriel V, Gallimore JR, Mc-
Millan SA, Grant J. A prospective study of the
sensitivity, specificity and diagnostic performance
of soluble intercellular adhesion molecule
1, highly sensitive C-reactive protein, soluble
E-selectin and serum amyloid A in the
diagnosis of neonatal infection. BMC Pediatr
2010;16:10-22.
55. Messer J, Eyer D, Donato L, Gallati H, Matis
J, Simeoni U. Evaluation of interleukin-6
and soluble receptors of tumor necrosis factor
for early diagnosis of neonatal infection. J
Pediatr 1996;129:574-80.
56. Resch B, Gusenleitner W, Müller WD. Procalcitonin
and interleukin-6 in the diagnosis of
early-onset sepsis of the neonate. Acta Paediatr
2003;92:243-5.
57. Ng PC, Li G, Chui KM, et al. Neutrophil
CD64 is a sensitive diagnostic marker for
early-onset neonatal infection. Pediatr Res
2004;56:796-803.
58. Benitz WE, Gould JB, Druzin ML. Risk factors
for early-onset group B streptococcal sepsis:
estimation of odds ratios by critical literature
review. Pediatrics 1999;103:e77.
59. Committee on Infectious Diseases; Committee
on Fetus and Newborn, Baker CJ,
Byington CL, Polin RA. Policy statement - Recommendations
for the prevention of perinatal
group B streptococcal (GBS) disease. Pediatrics
2011;128:611-6.
60. Escobar GJ, Li DK, Armstrong MA, et al.
Neonatal sepsis workups in infants >/=2000
grams at birth: A population-based study. Pediatrics
2000;106:256-63.
61. Berardi A, Lugli L, Baronciani D, et al.
Group B streptococcal infections in a Northern
region of Italy. Pediatrics 2007;120: e487-93.
62. Berardi A, Rossi C, Lugli L, et al. Group B
Streptococcus late-onset disease: 2003-2010.
Pediatrics 2013;131:e361-8.
63. Berardi A, Di Fazzio G, Gavioli S, et al. Universal
antenatal screening for group B Streptococcus
in Emilia-Romagna. J Med Screen
2011;18:60-4.
64. Berardi A, Tzialla C, Riva M, et al. Group B
Streptococcus: early- and late-onset infections.
J Chemother 2007;19:24-7.
65. Berardi A, Lugli L, Rossi C, et al. Group B
Streptococcus and preventive strategies in Europe.
Arch Dis Child Fetal Neonatal Ed 2008;
93:F249.
66. Berardi A, Lugli L, Rossi K, Tridapalli E,
Facchinetti F; GBS and Prevention Working
Group of Emilia-Romagna. Prevention of
group B streptococcal infection in a North-Italian
area. Pediatr Infect Dis J 2004;23:691-2.
67. Berardi A, Lugli L, Rossi C, et al. Impact
of perinatal practices for early-onset group-B
streptococcal disease prevention. Ped Infect
Dis J 2013;32:e265-71.
68. Cantoni L, Ronfani L, Da Riol R, et al. Physical
Examination Instead of Laboratory Tests
for Most Infants Born to Mothers Colonized
with Group B Streptococcus: Support for the
Centers for Disease Control and Prevention’s
2010 Recommendations. J Pediatr 2013;163
(2):568-73.
Corrispondenza: berardi.alberto@policlinico.mo.it