Late Onset ( after 72 hours ) Neonatal Sepsis on the Neonatal Unit
|Publication: 22/01/2015 --|
|Last review: 28/12/2017|
|Next review: 28/12/2020|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2017|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Late Onset (after 72 hours) Neonatal Sepsis on the Neonatal Unit
This guideline covers late onset sepsis (LONS) defined as sepsis occurring after 72 hours postnatal.
Many factors other than low birth weight or prematurity predispose neonates to LONS. These include
These infections are often associated with vascular catheters in babies in NICU, and coagulase-negative staphylococci (CoNS) are the most commonly reported pathogens. However, CoNS are the most common blood culture contaminants in patients in NICUs and optimal skin antisepsis and catheter disinfection before obtaining blood cultures needs to be reinforced.
Figure 1: Factors contributing to increased risk of LONS in premature infants.
Early diagnosis of LONS is a major challenge as the clinical manifestations are not. As a result there is significant over use of antibiotics in neonates. Antibiotics change newborn intestinal flora and bacterial resistance mechanisms and so common sense must prevail.
Risk Factors for LONS
These factors result in frequent exposure to opportunistic organisms during a prolonged hospital stay.
The importance of excellent hand hygiene and aseptic technique is paramount to reducing the risk of LONS in these vulnerable babies and cannot be over emphasised. In addition all medical staff caring for neonates have a responsibility to frequently look at line sites and review daily whether lines including cannulas are necessary or can be removed. The visual infusion phlebitis (VIP) score is there to ensure the timely removal of lines before infection or chemical irritation ensues.
Please refer to the guidelines for Peripherally Inserted Central (PIC) Lines in Neonates: and the guideline on prevention of Candidia Infection in Neonates
Signs and Symptoms
Differential diagnosis of LONS is wide. Please refer to the following guidelines as required:
If signs (hepatosplenomegally, thrombocytopenia, cataracts, congenital anomalies, intracranial calcificationsuggestive of congenital infection): ToRCH - Laboratory Investigation and Treatment of Suspected Congenital Infection with Cytomegalovirus, Toxoplasma or Rubella (ToRCH) in the Neonate
If Candida spp. have been isolated see: Invasive candidiasis:
In the case of suspected LONS the infant should have the following investigations:
Table 1: Antimicrobial recommendations
A guideline on how to prescribe Gentamicin is available:
All cultures should be checked 48 hours after being taken and if negative consider stopping antibiotics. If clinical features of sepsis or positive blood cultures discuss continuing treatment with a senior colleague.
Suspected infection in the newborn infant after 72 hours of age
|Target patient group:||Newborn infants under the care of the neonatal service|
|Target professional group(s):||Secondary Care Doctors
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- Beceiro Mosquera J, Sivera Monzo CL, Oria de Rueda SalgueroO, Olivas Lopez de Soria O, Herbozo Nory C. Usefulness of a rapid serum interleukin-6 test combined with CRP to predict sepsis in newborns with suspicion of infection. An Pediatr (Barc). 2009;71:483–488
- Fanaroff AA, Korones SB, Wright LL, et al. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The National Institute of Child Health and Human Development Neonatal Research Network. Pediatric Infect Dis J. 1998;17:593–598
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A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)
Improving Antimicrobial Prescribing Group
LHP version 1.0
Audit and Monitoring Compliance
This guideline will be audited against the standards of care set out. It will be incorporated into the departmental audit program and reviewed accordingly.
It will also be reviewed if indicated by local microbiological data and surveillance.
Audit results will be presented to the departmental audit meeting, which will agree actions arising from the recommendations, and monitor the progress of the actions.
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