Rivista di formazione e aggiornamento professionale del pediatra e del medico di base, fondata nel 1982.
In collaborazione con l'Associazione Culturale Pediatri.
A. Berardi, C. Spada, M. Ciccia, M Capretti, G. Brusa,
F. Sandri, E. Balestri, L. Rocca, L. Gambini, M. Azzalli,
V. Rizzo, G. Piccinini, E. Vaccina, L. Lucaccioni. OSSERVAZIONE NEL NEONATO A RISCHIO DI SEPSI PRECOCE. Medico e Bambino 2019;38:370-376 https://www.medicoebambino.com/?id=1906_370.pdf
Osservazione nel neonato a rischio di sepsi precoce
Observation on the newborn at risk of early-onset sepsis:
the approach of the Emilia-Romagna Region (Italy)
Alberto Berardi1, Caterina Spada2, Matilde Ciccia3, Mariagrazia Capretti4, Giacomo Brusa5, Fabrizio Sandri3, Eleonora Balestri6, Laura Rocca2, Lucia Gambini7, Milena Azzalli8, Vittoria Rizzo9,
Giancarlo Piccinini10, Eleonora Vaccina2, Laura Lucaccioni1
1Terapia Intensiva Neonatale (TIN), Azienda Policlinico, Modena; 2Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia; 3TIN, Ospedale Maggiore, Bologna; 4TIN, Azienda Policlinico Sant’Orsola - Malpighi, Bologna; 5TIN, Ospedale Infermi, Rimini; 6TIN, Arcispedale Santa Maria Nuova, Reggio Emilia; 7TIN, Azienda Policlinico, Parma; 8TIN, Arcispedale Sant’Anna, Ferrara; 9TIN, Ospedale Bufalini, Cesena; 10TIN, Ospedale Santa Maria Delle Croci, Ravenna
Giugno 2019 - pagg. 370 -376
Abstract
The approach to the newborn at risk of early-onset sepsis is a challenge. In the past the
approach was mainly based on laboratory tests, which were poorly predictive and
might cause repeated blood samples and unnecessary antibiotic therapies, with possible
long-term side effects. The medicalisation of asymptomatic newborns also interferes with
breastfeeding. Recent experiences carried out in the Friuli Venezia Giulia and Emilia-Romagna
Regions (Italy) have suggested that a less invasive approach is useful. This approach
is mainly based on careful and repeated clinical observations of asymptomatic
full-term or late preterm infants at standard intervals, regardless of risk factors. Moreover,
it is useful for a timely diagnosis, does not separate mothers from their neonates
and consequently does not interfere with the development of the nascent intestinal microbiota
and breastfeeding.
1. Schrag SJ, Farley MM, Petit S, et al. Epidemiology
of invasive early-onset neonatal sepsis,
2005 to 2014. Pediatrics 2016;138(6):
e20162013.
2. Berardi A, Baroni L, Bacchi Reggiani ML,
et al.; GBS Prevention Working Group Emilia-
Romagna. The burden of early-onset sepsis
in Emilia-Romagna (Italy): a 4-year, population-
based study. J Matern Fetal Neonatal
Med 2016;29(19):3126-31.
3. Centers for Disease Control and Prevention.
Active Bacterial Core surveillance
(ABCs) Report Emerging Infections Program
Network Group B Streptococcus. 2014.
4. Berardi A, Lugli L, Rossi C, et al; GBS Prevention
Working Group, Emilia-Romagna.
Impact of perinatal practices for early-onset
group B Streptococcal disease prevention.
Pediatr Infect Dis J 2013;32:e265-71.
5. Puopolo KM, Benitz WE, Zaoutis TE; AAP
Committee on Fetus and Newborn; AAP Committee
on Infectious Diseases. Management
of neonates born at ≤ 34 6/7 weeks’ gestation
with suspected or proven early-onset bacterial
sepsis. Pediatrics 2018;142:e2018-96.
6. Puopolo KM, Benitz WE, Zaoutis TE; AAP
Committee on Fetus and Newborn; AAP Committee
on Infectious Diseases. Management
of neonates born at ≥ 35 0/7 weeks’ gestation
with suspected or proven early-onset bacterial
sepsis. Pediatrics 2018;142:e2018-94.
7. Benitz WE. Adjunct laboratory tests in the
diagnosis of early-onset neonatal sepsis. Clin
Perinatol 2010;37(2):421-38.
8. Benitz WE, Wynn JL, Polin RA. Reappraisal
of guidelines for management of neonates
with suspected early-onset sepsis. J Pediatr
2015;166(4):1070-4.
9. Verani JR, McGee L, Schrag SJ. Division of
Bacterial Diseases, National Center for Immunization
and Respiratory Diseases, Centres
for Disease Control and Prevention
(CDC). Prevention of perinatal group B
streptococcal disease-revised guidelines
from CDC, 2010. MMWR Recomm Rep
2010;59(RR-10):1-36.
10. Hooven TA, Randis TM, Polin RA. What’s
the harm? Risks and benefits of evolving rule-
out sepsis practices. J Perinatol 2018;38
(6):614-22.
11. van Herk W, Stocker M, van Rossum AM.
Recognising early onset neonatal sepsis: an
essential step in appropriate antimicrobial
use. J Infect 2016;72 Suppl:S77-82.
12. Ficara M, Pietrella E, Spada C, et al.
Changes of intestinal microbiota in early life.
J Matern Fetal Neonatal Med 2018, Sep 10:1-
8 [Epub ahead of print].
13. Corvaglia L, Tonti G, Martini S, et al. Influence
of intrapartum antibiotic prophylaxis
for group B Streptococcus on gut microbiota
in the first month of life. J Pediatr Gastroenterol
Nutr 2016;62(2):304-8.
14. Randis TM, Polin RA, Saade G. Chorioamnionitis:
time for a new approach. Curr
Opin Pediatr 2017;29(2):159-64.
15. Cantoni L, Ronfani L, Da Riol R, Demarini
S; Perinatal Study Group of the Region Friuli
Venezia Giulia. Physical examination instead
of laboratory tests for most infants born to
mothers colonized with group B streptococcus:
support for the Centers for Disease Control and Prevention’s 2010 recommendations.
J Pediatr 2013;163(2):568-73.
16. Berardi A, Buffagni AM, Rossi C, et al.
Serial physical examinations, a simple and
reliable tool for managing neonates at risk
for early-onset sepsis. World J Clin Pediatr
2016;5(4):358-64.
17. Berardi A, Fornaciari S, Rossi C, et al. Safety
of physical examination alone for managing
well-appearing neonates ≥ 35 weeks’ gestation
at risk for early-onset sepsis. J Matern
Fetal Neonatal Med 2015;28(10):1123-7.
18. Illuzzi JL, Bracken MB. Duration of intrapartum
prophylaxis for neonatal group B
streptococcal disease: a systematic review.
Obstet Gynecol 2006;108(5):1254-65.
19. Bloom SL, Cox SM, Bawdon RE, Gilstrap
LC. Ampicillin for neonatal group B streptococcal
prophylaxis: how rapidly can bactericidal
concentrations be achieved? Am J Obstet
Gynecol 1996;175(4 Pt 1):974-6.
20. Barber EL, Zhao G, Buhimschi IA, Illuzzi
JL. Duration of intrapartum prophylaxis and
concentration of penicillin G in fetal serum at
delivery. Obstet Gynecol 2008;112(2 Pt
1):265-70.
21. Berardi A, Rossi C, Biasini A, et al. Efficacy
of intrapartum chemoprophylaxis less
than 4 hours duration. J Matern Fetal Neonatal
Med 2011;24(4):619-25.
22. Berardi A, Pietrangiolillo Z, Bacchi Reggiani
ML, et al. Are postnatal ampicillin levels actually
related to the duration of intrapartum antibiotic
prophylaxis prior to delivery? A pharmacokinetic
study in 120 neonates. Arch Dis Child
Fetal Neonatal Ed 2018; 103(2):F152-6.
23. Fairlie T, Zell ER, Schrag S. Effectiveness
of intrapartum antibiotic prophylaxis for prevention
of early-onset group B streptococcal
disease. Obstet Gynecol 2013;121(3):570-7.
24. Committee on Obstetric Practice. Committee
Opinion No. 712: Intrapartum Management
of Intraamniotic Infection. Obstet
Gynecol 2017;130(2):e95-e101.
25. Kuzniewicz MW, Puopolo KM, Fischer A,
et al. A quantitative, risk-based approach to
the management of neonatal early-onset sepsis.
JAMA Pediatr 2017;171(4):365-71.
26. Berardi A, Guidotti I, Vellani G, et al. La
gestione del nato a rischio di infezione precoce.
Medico e Bambino 2013;32(8):507-13.
27. Berardi A, Lugli L, Rossi C, et al. Neonatal
bacterial meningitis. Minerva Pediatr
2010;62(3 Suppl 1):51-4.
28. Berardi A, Cattelani C, Creti R, et al.
Group B streptococcal infections in the newborn
infant and the potential value of maternal
vaccination. Expert Rev Anti Infect Ther
2015;13(11):1387-99.
29. Berardi A, Ficara M, Pietrella E. Stewardship
antimicrobica nel neonato e nel piccolo
lattante. Perché e come praticarla. Medico e
Bambino 2017;36(8):493-501.
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