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Antibiotic regimens for suspected early neonatal sepsis

Antibiotics for newborn infants that might have blood infections when aged less than 48 hours. Blood infection (sepsis) can make newborn infants seriously ill or even kill them. Sepsis in newborns less than 48 hours old is called early neonatal sepsis. It is usually caused by bacteria passed from the mother. Doctors often give antibiotics if they suspect this dangerous condition because it can be difficult to tell if a newborn has early neonatal sepsis. Certain antibiotics can have significant side effects and their use can also lead to antibiotic resistance, which results in worse infection and possible damage to the intestines, kidneys, liver, or hearing. The authors of this review studied the medical literature to find out which kinds of antibiotics are best for suspected early neonatal sepsis, and what side effects these antibiotics cause. They found 15 relevant studies, but only two of these studies focused on infants less than 48 hours old. The two studies included a total of 127 newborns and compared newborns who received one antibiotic (monotherapy) to infants who received more than one antibiotic (combination therapy). There were no differences between the two groups. Both of the studies were published in the 1980s and are probably out of date. The authors of this review concluded that there is no evidence for using a particular kind of antibiotic for early neonatal sepsis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Oral lactoferrin for the treatment of sepsis and necrotizing enterocolitis in neonates

Newborn babies, especially those born prematurely, are at risk from infections in the blood (sepsis) and/or gastrointestinal inflammation and injury (necrotizing enterocolitis). A number of babies with sepsis or necrotizing enterocolitis die or suffer from long‐term brain and lung damage in spite of treatment with antibiotics. Lactoferrin, a substance normally present in human milk, may be effective against infections and gastrointestinal injury. This review searched for studies that used lactoferrin to treat babies with infection or gastrointestinal injury and found none. In view of the potential usefulness of lactoferrin, we recommend that well designed studies be done in the future to address this issue.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Vancomycin for prophylaxis against sepsis in preterm neonates

Premature babies have immature immune systems and frequently pick up harmful infections in the hospital. This means they are at high risk of sepsis (life‐threatening bacterial infection). The most common bacteria causing sepsis in neonatal intensive care are coagulase negative staphylococci (CoNS). One way of trying to prevent CoNS infection is by infusing low doses of the antibiotic vancomycin (giving the drug by intermittent infusion or continuous drip). The review of trials found that low dose continuous infusions, or low dose intermittent administration, of vancomycin reduce the risk of a baby getting sepsis in the neonatal intensive care unit. There is not enough evidence to show if this approach increases antibiotic resistance in nurseries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Recombinant human activated protein for severe sepsis in neonates

Sepsis (a generalized blood stream infection) is common in neonates. Severe sepsis carries a high mortality and morbidity even with current critical care management. Activated Protein C (APC) is a protein formed within the human body to prevent formation of blood clots and helps in breaking down clots. Recombinant human APC (rhAPC) is a synthesized version of APC using recombinant technology. It has been shown to reduce mortality in severe sepsis in adults. The review authors investigated whether treatment of severe sepsis in newborn infants with rhAPC will help to reduce mortality and severe morbidity. The review authors found no controlled studies in this age group. On October 25, 2011 rhAPC (Xigris®) was withdrawn from the market by Eli Lilly due to side effect in adults. RhAPC should no longer be used in any age category and the product should be returned to the distributor.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antibiotic regimens for suspected late onset sepsis in newborn infants

Antibiotics for newborn infants that might have blood infections when more than 48 hours old. Blood infection (sepsis) can make newborn infants seriously ill or even kill them. Sepsis in newborns more than 48 hours old is called late onset neonatal sepsis; it is usually caused by bacteria, and sometimes by fungal infection. Doctors often give antibiotics if they suspect this dangerous condition as it can be difficult to tell if a newborn has late onset neonatal sepsis. Certain antibiotics given for this condition can have serious side effects, including antibiotic resistance, which can result in worse infection. This Cochrane review examined which antibiotics are best for treating late onset neonatal sepsis, in terms of effectiveness and side effects. The authors searched the medical literature and found only one study that met all the criteria the authors were looking for. This study, from 1988, enrolled 28 newborn infants. Some of the newborns received a beta lactam antibiotic by itself while others got the beta lactam plus another antibiotic, an aminoglycoside. There were no significant differences between the two kinds of antibiotic treatment in this study. The Cochrane review authors concluded that there is not enough research to recommend one kind of antibiotic treatment over another for late onset neonatal sepsis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates

Sepsis is a bacterial or fungal infection of the blood. NEC is a condition with gastrointestinal tract injury and infection seen in premature babies. Modifying the body's response (inflammation) to infection may decrease deaths and tissue injury after sepsis or NEC. Pentoxifylline is a drug that decreases inflammation and possibly tissue injury. We reviewed the effects of pentoxifylline in newborn sepsis and NEC.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Oral lactoferrin for prevention of sepsis and necrotizing enterocolitis in preterm infants

Premature babies are at risk for blood infection (sepsis) and/or gastrointestinal injury (necrotizing enterocolitis, or NEC). A number of babies with sepsis or NEC die or develop long‐term brain and lung injury despite treatment with antibiotics. Lactoferrin, which is present in human milk, has been shown to be effective against infection when tested in animals and in the laboratory. Lactoferrin also enhances the ability of babies to fight infection. We found four studies that enrolled 1103 preterm babies. Evidence of moderate to low quality suggests that oral lactoferrin with or without a probiotic decreases sepsis and NEC in preterm infants with no adverse effects. When given alone, lactoferrin decreases deaths among preterm infants. We also found large studies that are ongoing, and their results when available may increase the strength of our analysis. Clarification regarding dosing, duration, type of lactoferrin (human or bovine), and development of preterm babies is still needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Umbilical cord antiseptics for preventing sepsis and death among newborns

The umbilical cord connects the baby and mother during pregnancy. The cord is cut after birth. The cord stump then dries and falls off, generally within five to 15 days. Infection of the umbilical cord stump (omphalitis), caused by skin bacteria, is a significant cause of illness and death in newborn babies in developing countries. This review evaluated all studies that assessed antiseptics applied topically to the umbilical cord to determine if they reduce the risk of cord infection and death. Thirty‐four randomised controlled studies were included involving 69,338 babies. There were 22 different interventions studied. The most commonly studied antiseptics in the included studies were 70% alcohol, triple dye and chlorhexidine. Three studies were conducted in community settings in developing countries; the remainder were conducted in hospital settings, mostly in developed countries. Studies conducted in community settings were large and contributed about 78% of all the participants included in this review. Hospital‐based studies were small and had limitations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antibiotics for meconium‐stained amniotic fluid in labour for preventing maternal and neonatal infections

Meconium‐stained amniotic fluid (MSAF) is the result of waste material from the fetal colon passing into the mother's amniotic cavity. Its incidence increases in post‐term pregnancies. Pregnant women with MSAF are more likely to develop maternal complications including inflammation of the fetal membranes caused by a bacterial infection (chorioamnionitis), postpartum inflammation of the lining of the uterus (endometritis) and neonatal complications such as neonatal sepsis and the need for admission to a neonatal intensive care unit (NICU). Fetal stress or hypoxia may trigger gasping fetal respirations, which results in the aspiration of meconium.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Prophylactic systemic antibiotics to reduce morbidity and mortality in neonates with central venous catheters

Central venous lines (long plastic tubes that have their tip ending in the big veins near the heart through which medicine and fluid can be given) are used in some newborn babies, particularly those that have been born too early or who are very sick. Babies with these lines are at risk of developing very serious blood infections, which may even cause death. Sometimes antibiotics are used to try to prevent these blood infections in babies with central venous lines. These preventive antibiotics may have unwanted side effects and could increase the likelihood of infections that are resistant to treatment. Therefore, it is possible that the risks of using antibiotics outweigh the potential benefits. Three small trials of 271 babies were included in this review. The results of these studies show that it is possible to reduce the chance of serious blood infection occurring, but that almost 10 babies need to be given preventive antibiotics to avoid one case of infection. There was no difference in the likelihood of death. There were not enough data on other important effects of the antibiotics or on the possible serious side effects. There was not much similarity between the studies included in this review. Therefore, there is currently not enough evidence to recommend routinely using antibiotics in babies with central venous lines.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters

There is no evidence to support or refute the use of preventive antibiotics in newborn babies with drainage tubes placed in the chest. Sick newborn babies occasionally need the insertion of a tube that is placed through the skin and into the lung space to drain air or fluid from around their lungs. Because this process involves breaching the skin barrier, there is a potential risk of infection. The group of babies most likely to need this procedure are also those that are most at risk of developing an infection during their stay in hospital. Preventive antibiotics are commonly used when there is a risk of infection, but they may have unwanted effects. The review authors found no evidence to support or refute the use of routine preventive antibiotics when intercostal catheters are inserted in newborn babies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Intravenous immunoglobulin for suspected or proven infection in neonates

Infants may acquire infection while in the womb or in the hospital after birth, especially if they require intensive care. Such infections may cause serious illness or death. Maternal transport of immunoglobulins (substances in the blood that can fight infection) to the fetus mainly occurs after 32 weeks' gestation, and infants do not begin to produce their own immunoglobulins until several months after birth. Theoretically, the adverse effects of infection could be reduced by the administration of intravenous immunoglobulin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Gentamicin dosage in neonates

Gentamicin is a commonly used antibiotic that is very effective in treating bacterial infections in neonates. However, gentamicin may cause adverse effects on auditory and renal functions that may be related to the dosage, interval and in turn the drug levels in plasma. Safer and potentially more effective levels of the drug were maintained using a one dose per day treatment schedule.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The health benefits and harms for mothers and their babies with pregnancies complicated with ruptured membranes before term

When a pregnant woman's membranes break before 37 weeks' gestation in pregnancy without contractions, the management choice is to deliver the baby soon or to wait for spontaneous labour to occur or delivery at term. The health benefits for continuing a pregnancy can depend on how near the mother is to term and so the likelihood of risks of prematurity, including respiratory distress and prolonged stays in the neonatal nursery. Remaining in the womb has potential harms for both mother and baby including infections that can cause neonatal sepsis, fetal distress and death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding group B streptococcal and HIV)

Bacteria live in women's vaginas and generally cause no problems. Very occasionally they infect the placenta during labour and can pass to the baby, causing an infection. These infections can occasionally make the baby very ill and very occasionally the baby might die.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters

Critically ill or premature babies (born before 37 weeks of pregnancy) often need medication and feeding through their veins. These veins are small and fragile so repeated injections can be hard and painful for the baby. A central catheter is a small tube that can be inserted into the vein, allowing medications and other liquids to be given to the baby for a prolonged period. It can get dislodged, blocked or infected. The drug heparin allows to complete intended therapy in more patients without increasing complications of bleeding or allergic reactions. The review found that there was now evidence to show benefit of heparin. If it is used routinely, careful monitoring of side effects is warranted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Topical umbilical cord care at birth

No evidence that applying sprays, creams or powders are any better than keeping the baby's cord clean and dry at birth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Prophylactic versus selective antibiotics for term newborn infants of mothers with risk factors for neonatal infection

Several factors increase the risk of serious infection in term newborn infants, for example, the presence in the birth canal of a bacterium that causes infection in the newborn (group B streptococcus), rupture of membranes more than a day before delivery, or high temperature in the mother during labour. Some paediatricians routinely prescribe an antibiotic for the newborn infant if any of these factors is present, even if the infant appears to be completely well. Others believe that it is safe and appropriate to observe these infants and only treat those who develop signs of illness, or have other evidence of infection during the first day after birth. We found two small trials that addressed this question. Neither provided enough evidence to guide practice. A further larger randomized trial is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Maternity waiting facilities for improving maternal and neonatal outcomes in low‐resource countries

The chances of women dying because of complications of pregnancy and childbirth are still high in many parts of the world. The main direct causes of maternal and perinatal deaths are unsafe abortion, eclampsia, haemorrhage, obstructed labour, infections and sepsis. Most of these deaths can be prevented with early identification and treatment of complications. The poor utilisation of maternal health services and antenatal care in areas where deaths are high is mainly the result of barriers to access.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Interventions for treatment of neonatal hyperglycemia in very low birth weight infants

Higher‐than‐normal blood sugar levels are frequently seen in babies born very early (before 32 weeks gestation) or with very low birth weight (< 1500 grams) and who are fed totally or partially by vein. Several types of adverse outcomes have been associated with high blood sugar levels, including increased risks for death, infections, eye problems, and bleeding into the brain. It is not known if treatment to lower the baby's blood sugar helps to prevent those complications and, if so, which treatment is best. These treatment options include decreasing the amount of sugar delivered by vein to nourish the baby or administration of insulin. This review of trials found no evidence of significant effects of these treatments on the risks of death or major complications. However, the studies reviewed were very small. There is a need for larger trials to answer these questions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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