56: Culture-Positive Neonatal Sepsis in a Level II Nursery
Bibliographic record
Abstract
The incidence of ‘early-onset neonatal sepsis’ (EONS) has significantly declined in North America following the implementation of guidelines for intrapartum antibiotic prophylaxis for Group B streptococcus, but the Canadian rates of EONS are not well defined. Each year, approximately 600 newborns are admitted to our Level II Intermediate Nursery (IN), of whom many receive antibiotics for ‘rule out sepsis’. However the incidence of culture-proven EONS and the distribution of pathogenic bacteria in this population is presently not well defined. The primary purpose of this study is to determine the incidence of culture-positive blood infections in infants admitted to the Level II Intermediate Nursery (IN). Secondary aims will be to characterize patterns of bacterial susceptibility, specifically to the antibiotics that are currently used to treat neonatal sepsis in the IN. In this study, blood cultures from neonates admitted to the Level II nursery over a three-year period from 2007 to 2009 were retrospectively reviewed. Ethical approval was obtained prior to data collection. Admission criteria were: >33 weeks gestation, birth weight >1500 g, mild to moderate respiratory distress, infants requiring IV fluid, infants at risk for abnormal transition, cord pH <7.0, and infants with congenital anomalies requiring observation. We excluded infants admitted from other hospitals and infants transferred to the Intermediate Nursery from the Level III NICU. Charts for infants with positive blood cultures were evaluated for clinical signs and symptoms of sepsis using our centres established sepsis protocol. The incidence of EONS was determined, and the offending bacterial pathogens were characterized. A total of 733 blood cultures were reviewed during the three-year period, of which 12 were positive for bacterial growth. Six were identified as contaminants based on species and clinical manifestation. The overall incidence of EONS was found to be between 0.4% to 1.3% of cultured patients, with the most common organisms being coagulase-negative Staphylococci, followed by Streptococcus agalactiae. All clinically significant isolates were sensitive to ampicillin and gentamycin. The incidence of culture positive EONS in a cohort of neonates >33 weeks' gestation at a major Canadian level II nursery is extremely low. In light of these findings future work will focus on further characterizing risk factors for true EONS, with a view to reducing the number of infants, at potential risk, who receive empiric antibiotics in the first days of life. This would have positive implications for the burden of care of IV antibiotic administration, as well as financial savings and benefits for the gut microbiome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".