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Table 3 Management of newborns ≥34 weeks’ GA according to our local guidelines

From: Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines

EOS risk categories

Management

High-risk patients

Full diagnostic evaluationab and empirical antibioticsc pending the results of the evaluation

CRP and PCT at 24 ± 4 h of lifeb

CRP and PCT at 48 ± 4 h of lifeb

CRP and PCT at 72 ± 4 h of lifeb

Medium-risk patients

Limited diagnostic evaluationdb

CRP and PCT at 24 ± 4 h of lifeb

CRP and PCT at 48 ± 4 h of lifeb

CRP and PCT at 72 ± 4 h of lifeeb

Further exams (CBC, blood culture)b and empirical antibioticsc in presence of one clinical indicator of EOS and one of the following conditions: 1) Abnormal cord blood PCTb; 2) Abnormal neonatal PCT before 28 h of lifeb; 3) Abnormal neonatal CRP and PCT after 28 h of lifeb

Low-risk patients

Routinely observation for ≥48 h before discharge

  1. The whole study population included all newborns ≥34 weeks’ GA consecutively admitted to the Neonatology Department of Santa Chiara Hospital (Pisa, Italy) during the study period. The selection process of the study participants is represented in Fig. 1; the study groups included all newborns ≥34 weeks’ GA, newborns 34–36 weeks’ GA, and newborns ≥37 weeks’ GA. All included patients have been managed in accordance with our local guidelines
  2. CBC Cell blood count, CRP C-reactive protein, EOS Early-onset sepsis, GA Gestational age, PCT Procalcitonin
  3. aCord blood CRP and PCT or measurement of both markers within the first hour of life or at the onset of symptoms, blood culture and complete blood count (CBC) before receiving empirical antibiotics
  4. bThe quantities of blood used for laboratory analyses are the following ones: 200 μL for CRP or PCT, 300 μL for both CRP and PCT, 400 μL for CBC and 1 mL for blood culture. Measurement of CRP and/or PCT is also possible on capillary blood samples. Cord blood CRP ≥ 10 mg/L and cord blood PCT ≥ 0.6 ng/mL are considered pathological; CRP ≥ 10 mg/L is considered abnormal even when performed on neonatal blood samples. PCT requires adjustment of the cut-off point with time according to the age-specific 95% reference intervals by Chiesa et al., when performed on neonatal blood samples [17]
  5. cIntravenous ampicillin-sulbactam and gentamicin. Prophylaxis with empirical antibiotics is interrupted at 72 ± 4 h of life in asymptomatic patients with negative blood culture and normal neonatal CRP and PCT. Antibiotic treatment is continued for another 4–11 days, for a total of 7–14 days, in the following cases: 1) Patients with clinical indicators of EOS at 72 ± 4 h of life; 2) Abnormal CRP and/or PCT at 72 ± 4 h of life; 3) Positive blood culture
  6. dCord blood CRP and PCT or measurement of both markers within the first hour of life or at the onset of symptoms
  7. eOnly symptomatic patients and preterm newborns