Neonatal sepsis is one of the major life-threatening diseases in neonates, with significant regional variations in mortality. The Subspecialty Group of Neonatology, Society of Pediatrics, Chinese Medical Association, together with the Editorial Board of the Chinese Journal of Contemporary Pediatrics, organized neonatology experts to integrate the latest advances in clinical research on neonatal sepsis. Taking into account the current situation of primary healthcare institutions in China, they addressed nine common clinical questions regarding the diagnosis, treatment, and referral of neonatal sepsis for primary healthcare providers, and resulting in 19 expert consensus recommendations. This consensus aims to help primary healthcare providers promptly identify neonatal sepsis, ensure timely intervention or referral, and improve clinical outcomes.
Humans ; Infant, Newborn ; Neonatal Sepsis/therapy* ; Primary Health Care ; Consensus

OBJECTIVE: To evaluate the efficacy of sepsis risk calculator (SRC) in guiding antibiotic use in neonates with suspected early-onset sepsis (EOS). METHODS: A total of 284 neonates with a gestational age of ≥ 35 weeks were enrolled as the control group, who were hospitalized in the Children's Hospital of Chongqing Medical University from March to July, 2019 and were suspected of EOS. Their clinical data were retrospectively collected and the use of antibiotics was analyzed based on SRC. A total of 170 neonates with a gestational age of ≥ 35 weeks were enrolled as the study group, who were admitted to the hospital from July to November, 2020 and were suspected of EOS. SRC was used prospectively for risk scoring to assist the decision making of clinical antibiotic management. The two groups were compared in terms of the rate of use of antibiotics, blood culture test rate, clinical outcome, and adherence to the use of SRC. RESULTS: Compared with the control group, the study group had a significantly higher SRC score at birth and on admission ( CONCLUSIONS The use of SRC reduces the rate of empirical use of antibiotics in neonates with suspected EOS and does not increase the risk of adverse outcomes, and therefore, it holds promise for clinical application.
Anti-Bacterial Agents/therapeutic use* ; Child ; Humans ; Infant ; Infant, Newborn ; Neonatal Sepsis/drug therapy* ; Retrospective Studies ; Risk Assessment ; Sepsis/drug therapy*

BACKGROUND: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5°C–37.5°C. PURPOSE: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. METHODS: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. RESULTS: The mean admission temperature was 36.1°C±0.6°C, with a range of 31.9°C to 38.4°C. Approximately 74.1% of infants had an admission hypothermia of <36.5°C. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5°C–37.5°C and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04–1.83), 1.44 (95% CI, 1.05–1.97) and 1.86 (95% CI, 1.22–2.82) for infants with admission temperatures of 36.0°C–36.4°C, 35.0°C–35.9°C, and <35.0°C, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. CONCLUSION: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.
Apgar Score ; Birth Weight ; Body Temperature ; Bronchopulmonary Dysplasia ; Cohort Studies ; Delivery Rooms ; Hemorrhage ; Hospital Mortality ; Humans ; Hypertension, Pulmonary ; Hypothermia ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intubation ; Korea ; Laser Therapy ; Mortality ; Parturition ; Pregnancy ; Prospective Studies ; Retinopathy of Prematurity ; Seizures ; Sepsis

OBJECTIVETo investigate the effects of antibiotic stewardship on the pathogen and clinical outcome of neonatal bloodstream infections (BSIs).

METHODSA retrospective study was performed on neonates with BSIs who were admitted to the neonatal ward in the years of 2010 (pre-stewardship) and 2013 (post-stewardship) for pathogens, antibiotic resistance, antibiotic use, and clinical outcomes.

RESULTSThe admission rate of BSIs (6.47% vs 2.78%) and the incidence of nosocomial BSIs (0.70% vs 0.30%) in 2013 were significantly higher than in 2010 (P<0.01). However, there were no signicant differences in the clinical outcomes between the years of 2010 and 2013 (P>0.05). The four most common pathogens isolated from blood cultures, Staphylococcus haemolyticus, Staphylococcus epidermidis, Klebsiella pneumoniae ssp pneumoniae and E.coli, were similar between the two years. There were no significant differences in the detection rates of extended spectrum β-lactamase-positve Klebsiella pneumoniae ssp pneumoniae or E.coli between the two years. The detection rates of methicillin-resistant Staphylococcus/β-lactamase-positive Staphylococcus haemolyticus and Staphylococcus epidermidis were similar between the two years (P>0.05).

CONCLUSIONSSince the implementation of antibiotic stewardship, there has been no marked variation in the common pathogens and their antibacterial resistance in neonatal BSIs. The antibiotic stewardship could promote the recovery of patients with BSIs.

Anti-Bacterial Agents ; therapeutic use ; Bacteria ; isolation & purification ; Drug Resistance, Microbial ; Humans ; Infant, Newborn ; Neonatal Sepsis ; drug therapy ; microbiology ; Retrospective Studies ; Time Factors

PURPOSE: Thyroid dysfunction is common in preterm infants. Congenital hypothyroidism causes neurodevelopmental impairment, which is preventable if properly treated. This study was conducted to describe the characteristics of thyroid dysfunction in very low birth weight infants (VLBWIs), evaluate risk factors of hypothyroidism, and suggest the reassessment of thyroid function with an initially normal thyroid-stimulating hormone (TSH) as part of a newborn screening test. METHODS: VLBWIs (January 2010 to December 2012) were divided into two groups according to dysfunction-specific thyroid hormone replacement therapy, and associated factors were evaluated. RESULTS: Of VLBWIs, 246 survivors were enrolled. Only 12.2% (30/246) of enrolled subjects exhibited thyroid dysfunction requiring thyroid hormone replacement. Moreover, only one out of 30 subjects who required thyroid hormone treatment had abnormal thyroid function in the newborn screening test with measured TSH. Most of the subjects in the treatment group (22/30) exhibited delayed TSH elevation. Gestational age, Apgar score, antenatal steroids therapy, respiratory distress syndrome, patent ductus arteriosus, sepsis, intraventricular hemorrhage, postnatal steroids therapy, and duration of mechanical ventilation did not differ between the two groups. Birth weight was smaller and infants with small for gestational age were more frequent in the treatment group. CONCLUSION: Physicians should not rule out suggested hypothyroidism, even when thyroid function of a newborn screening test is normal. We suggest retesting TSH and free thyroxine in high risk preterm infants with an initially normal TSH level using a newborn screening test.
Apgar Score ; Birth Weight ; Congenital Hypothyroidism ; Ductus Arteriosus, Patent ; Gestational Age ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Hypothyroidism ; Infant ; Infant, Newborn ; Infant, Premature* ; Infant, Very Low Birth Weight* ; Mass Screening ; Neonatal Screening ; Respiration, Artificial ; Respiratory Therapy ; Risk Factors ; Sepsis ; Steroids ; Survivors ; Thyroid Function Tests ; Thyroid Gland* ; Thyrotropin ; Thyroxine

OBJECTIVETo realize the difference between China and France in the clinical manifestations, diagnosis and treatment of early-onset neonatal sepsis (EONS) and to provide basis to improve the level of our hospital in diagnosing and treating this disease.

METHODData of 146 cases of EONS were retrospectively analyzed. All data were collected from our hospital and a French hospital. Bacterial spectrum, clinical manifestations, use of antibacterial drugs, occurrence of recording and screening of perinatal risk factors were compared between the two hospitals.

RESULTThe most common pathogenic bacteria in our hospital were coagulase-negative staphylococcus (69.2%) and Escherichia coli (15.4%) while in the French Hospital, group B streptococcus (33.3%) and Escherichia coli (33.3%). The most common pathogenic bacteria in gastric liquid and peripheral swabs of the French hospital were Escherichia coli (33.3%) and group B streptococcus (21.2%). Total days of antibacterial use 11.4 ± 7.2 (d), mean sorts of antibacterial drugs for single patient (3.1 ± 0.9) and proportion of patients who had antibacterial drug changes (70.2%) were greater than the French hospital 6.2 ± 2.5 (d), 2.2 ± 0.8(d), (9.9%). Both hospitals were inclined to combine 2 antibacterial drugs for the first dose (second-generation cephalosporins + semi-synthetic penicillin in our hospital vs. amoxicillin + amikacin in the French hospital). The common second and third line antibacterial drugs in our hospital are carbapenems and vancomycin vs. third-generation cephalosporins and vancomycin in the French hospital. The rates of occurrence of recording and screening perinatal risk factors (chorioamnionitis, maternal fever, prolonged rupture of membranes, screening results of vaginal swabs or urinary infection, amniotic fluid contamination, prenatal antibacterial prophylaxis, anamnesis of EONS) in our hospital was all lower than those of the French hospital. There was no significant difference in positive rate of perinatal risk factors between the two hospitals. For newborns hospitalized for immediate abnormalities after birth, the most common symptom was respiratory distress (96.5% vs. 88.2%). For those admitted after a period of time after birth, the proportion of abnormalities was different: in our hospital, the most common reasons were respiratory distress (44.4%) and lethargy (22.2%) while in the French hospital there were rise of C reactive proteins (78.2%) and fever (5.5%). The false negative rate of C reactive proteins in diagnosing EONS was not significantly different between the two hospitals.

CONCLUSIONThere was significant difference in diagnosing and treating EONS in the two hospitals. Emphasis on screening and recording perinatal risk factors, as well as strengthened surveillance on neonates in obstetric department could improve the accuracy of early diagnosis of EONS of our hospital. Positive attitude to gastric liquid and peripheral swabs culture, with drug susceptibility test may help pediatricians better select antibacterial drugs and reduce unnecessary changes and the total time of antibiotic use.

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; C-Reactive Protein ; analysis ; China ; Drug Resistance, Microbial ; Escherichia coli ; drug effects ; isolation & purification ; Female ; France ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; drug therapy ; microbiology ; Male ; Microbial Sensitivity Tests ; Neonatal Screening ; methods ; Pregnancy ; Pregnancy Complications ; diagnosis ; Prenatal Diagnosis ; methods ; Retrospective Studies ; Risk Factors ; Sepsis ; diagnosis ; drug therapy ; microbiology ; Staphylococcus ; drug effects ; isolation & purification ; Streptococcus agalactiae ; drug effects ; isolation & purification

OBJECTIVETo analyze the clinical characteristics of Candida septicemia occurred in neonatal intensive care unit (NICU).

METHODSThe clinical characteristics of 9 confirmed cases with septicemia caused by Candida species yeasts were analyzed and summarized.

RESULTSAll the 9 cases were preterm infants, including 6 cases of very low birth weight infants. All these cases were treated with broad-spectrum antibiotics and parenteral nutrition before fungal infections occurred. Eight cases had percutaneous inserted central catheter (PICC). Three cases had been on ventilator. The symptoms of fungal infection were presented at 8 to 22 days of age. Apnea, poor perfusion and lethargy were common symptoms of these cases with fungal infection. Seven of the 9 cases developed thrombocytopenia. C reactive protein was elevated in 7 cases. Blood culture showed C. albicans in 1 case, C. parapsilosis in 2 cases, and C. guilliermondii in 6 cases. In 5 cases PICC culture showed the same fungus as blood culture revealed at the same time. All the 9 patients received antifungal therapy. Six patients were cured, two died and in one patient the treatments were given up by the parents.

CONCLUSIONSThe high risk factors of Candida septicemia in newborn infants include preterm, PICC, broad-spectrum antibiotic therapy and mechanical ventilation. The clinical presentations are always nonspecific. Thrombocytopenia and elevated C reactive protein are common in Candida septicemia patients. Early-started antifungal therapy can improve the prognosis.

Antifungal Agents ; therapeutic use ; C-Reactive Protein ; metabolism ; Candida ; drug effects ; isolation & purification ; pathogenicity ; Candidiasis ; physiopathology ; therapy ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Male ; Prognosis ; Risk Factors ; Sepsis ; complications ; microbiology ; physiopathology ; therapy ; Thrombocytopenia ; microbiology ; Treatment Outcome

BACKGROUND AND OBJECTIVES: When screened using cord blood, congenital hearing loss are detected more frequently than other congenital metabolic diseases such as phenylketonuria or congenital hypothyroidism. Newborn hearing screening is important because the early identification and intervention of neonatal hearing loss is beneficial for the language development. We aimed to analyze clinical characteristics including associated diseases and present hearing state, and the effects of speech rehabilitation in the hearing-impaired infants detected by newborn hearing screening program of Ajou University Hospital. SUBJECTS AND METHOD: Seventy nine hundred twelve neonates (6915 well babies and 997 NICU babies) were screened by transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR). Medical records of infants with bilateral hearing loss of more than 60 dB were evaluated, and they were further studied with temporal bone CT scan and follow-up hearing tests using ABR. The exon2 of the connexin26 gene was sequenced to detect the mutation. RESULTS: Fourteen of 7912 infants initially had bilateral hearing loss of more than 60 dB. Associated diseases were prematurity, hyperbilirubinemia, sepsis, low birth weight, chromosomal anomaly, cleft palate, congenital nevus, and congenital aural atresia. Three of 14 infants were revealed to have normal hearing after follow-up hearing test, which were associated with cleft palate, hyperbilirubinemia or prematurity. One of them had 235delC mutation of the connexin26, and the temporal bone CT scan demonstrated the finding of enlarged vestibular aqueduct syndrome (EVAS) in one infant. Two infants participated in the connected speech rehabilitation program and showed significant development of language. CONCLUSION: Follow-up hearing tests are important in case of failures of newborn hearing screening test. The establishment of auditory and speech rehabilitation program connected with newborn hearing screening is essential in treating hearing-impaired neonates.
Cleft Palate ; Congenital Hypothyroidism ; Evoked Potentials, Auditory, Brain Stem ; Fetal Blood ; Follow-Up Studies* ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Tests ; Hearing* ; Humans ; Hyperbilirubinemia ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn* ; Language Development ; Mass Screening* ; Medical Records ; Metabolic Diseases ; Neonatal Screening ; Nevus ; Phenylketonurias ; Rehabilitation ; Sepsis ; Speech Therapy ; Temporal Bone ; Tomography, X-Ray Computed ; Vestibular Aqueduct