Targeted antibiotics, monitoring, and prevention of neonatal sepsis
THE CONTEXT
Neonatal sepsis care includes culture-directed antimicrobial treatment, individualized monitoring, antibiotic stewardship, and preventive newborn-care practices.
Culture-directed treatment
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Antimicrobial treatment can become specific once a positive culture and sensitivity report is available, usually after 2–3 days.
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The BACTEC automated blood culture system uses a fluorescence principle involving carbon dioxide released by microorganisms to aid early detection.
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Even in the best institutions, only approximately one-fourth of neonates suspected of sepsis have positive blood cultures.
Administration and possible treatment switch
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Antibiotics should preferably be administered parenterally.
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For septicemia or pneumonia, excluding meningitis, a neonate who is clinically well after three days of initial intravenous ampicillin and gentamicin may be considered individually for a switch to oral amoxicillin with single-dose intramuscular gentamicin therapy for the remaining course.
Monitoring and antibiotic stewardship
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Intensive care and monitoring are key determinants of improved neonatal survival. Monitoring supports early detection of complications.
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The frequency of documenting monitoring parameters should be individualized.
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An antibiotic stewardship program aims to provide the right antibiotic at the right time and dose, for the right duration, through the right route.
Prevention
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Use the six cleans at delivery: clean hands, a clean delivery surface, a clean perineum, clean and dry cord care, clean cutting instruments, and clean towels.
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Promote exclusive breastfeeding or feeding with the mother's own milk, and maintain hand hygiene among healthcare staff.