Spectrum: Local Antimicrobial Stewardship, for Yangon Children's Hospital

Early Onset Sepsis (EOS)

Reinforce infection prevention and control procedures

Risk Factors

  • Preterm or low birth weight

  • Premature rupture of membranes

  • Prolonged rupture of membranes (>18 hours)

  • Spontaneous preterm onset of labour <37 weeks gestation

  • Maternal intrapartum fever: >37.5ºC <2 weeks prior to delivery

  • Signs of chorioamnionitis (e.g. smelly liquor) or malodorous baby

  • Prolonged and difficult delivery with instrumentation

  • Vaginal GBS colonization, previous baby with GBS sepsis

  • Maternal history of urinary tract infection (UTI)

  • Apgar score <4 at 1 minute of age

  • More than 3 vaginal examinations during labour

Aetiological Agents

Duration

Antibiotics can either be continued or modified based on the culture report and clinical condition

  • If culture negative, consider stopping therapy

  • Continue therapy if sepsis is very likely even though culture comes back as negative

Situation-based duration
Situation Duration
Clinical course and laboratory findings do not verify the suspected infection 48 hours (max.)
Infection is confirmed (evidence of pathogens + laboratory studies and/or clinical presentation) 7 days
Blood culture is positive and/or severe illness 10 days
Meningitis (some guidelines recommend treatment for an additional week after the last negative CSF) 14-21 days
Osteomyelitis ≥3 weeks

Treatment

Cases of unknown origin

Cases of severely ill term/preterm newborn, or preterm infants with a prenatal history indicating bacterial infection

e.g. Maternal fever, foul smelling liquour, PROM >18hrs etc.

Cases of initial treatment failure where pathogens are still unknown

Supportive care