Intermittent hypoxemic events in term and preterm infants with proven and unproven early onset sepsis: Opportunities for antibiotic stewardship

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Background: Nonspecific clinical signs and suboptimal diagnostic tests limit accurate identification of term and preterm infants with early onset sepsis, resulting in significant antibiotic overuse. Unnecessary and excess exposure to empiric broad-spectrum antibiotics is associated with significant morbidity in the neonatal population. Intermittent hypoxemic event burden during the first two days of life may help in discriminating true sepsis from a negative sepsis evaluation and aid in a more targeted approach to antibiotic treatment decisions.

Objectives: To compare the intermittent hypoxemic events burden in term and preterm infants with true early onset sepsis and negative sepsis evaluation during the first two days of life.

Method: Infants admitted to the neonatal intensive care unit from 2014-2018 that underwent prospective continuous SpO2 recording from birth through first two days of life were included. Intermittent hypoxemic event burden (SpO2<80%) was obtained as event duration at least ≥10 sec and < 5 min. Events with data gaps greater than 20% were excluded. Data from infants with positive blood cultures for a recognized pathogen were compared to gestational age and birth weight matched controls with negative sepsis evaluations.

Results: A total of 5,967,456 valid SpO2 data points were collected during the first 48 hrs of life in 36 infants with proven early onset sepsis (gestational age=31.6±5.5 weeks, birth weight=1871±1105g) and 56 infants (gestational age=31.9±5.4 weeks, birth weight=1897±1076 g) with negative sepsis evaluation. There was a 38% greater mean duration of events (p<0.05) on the first day of life in infants with true early onset sepsis compared to infants with negative sepsis evaluation; a similar (non-significant) trend was noted on the second day of life (Figure 1).

Conclusions: Intermittent hypoxemic event burden during the first two days of life can assist decisions for continuation or earlier discontinuation of empiric antibiotics among term and preterm infants with suspected early onset sepsis.

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Columbia University Irving Medical Center
University of Michigan
Columbia University Medical Center
Columbia University
Columbia University Medical Center

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