Glaser Margaret A, Hughes Lauren M, Jnah Amy, Newberry Desi
Neonatal Nurse Practitioner Program, ECU College of Nursing, Greenville, North Carolina.
Adv Neonatal Care. 2021 Feb 1;21(1):49-60. doi: 10.1097/ANC.0000000000000769.
Early-onset sepsis, occurring within 72 hours of birth, and late-onset sepsis, occurring after this time period, present serious risks for neonates. While culture-based screening and intrapartum antibiotics have decreased the number of early-onset cases, sepsis remains a top cause of neonatal morbidity and mortality in the United States.
To provide a review of neonatal sepsis by identifying its associated risk factors and most common causative pathogens, reviewing features of the term and preterm neonatal immune systems that increase vulnerability to infection, describing previous and the most current management recommendations, and discussing relevant implications for the neonatal nurse and novice neonatal nurse practitioner.
METHODS/SEARCH STRATEGY: An integrative review of literature was conducted using key words in CINAHL, Google Scholar, and PubMed.
FINDINGS/RESULTS: Group B streptococcus and Escherichia coli are the most common pathogens in early-onset sepsis, while Coagulase-negative staphylococci comprise the majority of cases in late-onset. The neonatal immune system is vulnerable due to characteristics including decreased cellular activity, underdeveloped complement systems, preferential anti-inflammatory responses, and insufficient pathogenic memory. Blood cultures remain the criterion standard of diagnosis, with several other adjunct tests under investigation for clinical use. The recent development of the sepsis calculator has been a useful tool in the management of early-onset cases.
It is vital to understand the mechanisms behind the neonate's elevated risk for infection and to implement evidence-based management.
Research needs exist for diagnostic methods that deliver timely and sensitive results. A tool similar to the sepsis calculator does not exist for preterm infants or late-onset sepsis, groups for which antibiotic stewardship is not as well practiced.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=40.
早发型败血症发生在出生后72小时内，晚发型败血症发生在此时间段之后，对新生儿构成严重风险。虽然基于培养的筛查和产时抗生素已减少了早发型病例的数量，但在美国，败血症仍是新生儿发病和死亡的主要原因。
通过识别新生儿败血症的相关危险因素和最常见的致病病原体，回顾足月儿和早产儿免疫系统中增加感染易感性的特征，描述以往和最新的管理建议，并讨论对新生儿护士和新手新生儿执业护士的相关影响，对新生儿败血症进行综述。
方法/搜索策略：使用CINAHL、谷歌学术和PubMed中的关键词进行文献综合综述。
B族链球菌和大肠杆菌是早发型败血症最常见的病原体，而凝固酶阴性葡萄球菌在晚发型病例中占大多数。新生儿免疫系统由于细胞活性降低、补体系统发育不全、优先抗炎反应和致病记忆不足等特征而容易受到感染。血培养仍然是诊断的标准方法，其他几种辅助检查正在进行临床研究。败血症计算器的最新开发是管理早发型病例的有用工具。
了解新生儿感染风险升高背后的机制并实施循证管理至关重要。
需要能够提供及时和敏感结果的诊断方法的研究。对于早产儿或晚发型败血症不存在类似于败血症计算器的工具，而抗生素管理在这些群体中实施得并不理想。视频摘要可在https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=40获取。
