What is the management of newborns delivered to a febrile mother?

From the Guidelines

Newborns delivered to febrile mothers should undergo a complete sepsis evaluation and empiric antibiotic therapy with ampicillin and gentamicin, and be monitored closely in a neonatal unit for at least 48-72 hours. The management of newborns delivered to a febrile mother is crucial to prevent early-onset sepsis, which can progress rapidly in newborns due to their immature immune systems 1.

Key Considerations

• A full diagnostic evaluation should include blood cultures, complete blood count with differential, and C-reactive protein, as well as a lumbar puncture if feasible, as blood cultures can be sterile in as many as 15% of newborns with meningitis 1.
• Empiric antibiotic therapy should be initiated promptly with ampicillin (100-200 mg/kg/day divided every 12 hours) and gentamicin (4-5 mg/kg/day for term infants) while awaiting culture results.
• The newborn should be monitored closely in a neonatal unit for at least 48-72 hours with vital signs checked every 4 hours, including temperature, heart rate, respiratory rate, and oxygen saturation.
• If the mother received antibiotics before delivery, false-negative cultures are possible, so clinical judgment is crucial 1.
• Breastfeeding should be encouraged unless contraindicated by maternal medication.

Special Considerations

• Well-appearing infants whose mother had an indication for GBS prophylaxis but received no or inadequate intrapartum antibiotics can be managed with observation for ≥48 hours, unless the infant is <37 weeks and 0 days’ gestational age or membranes were ruptured ≥18 hours before delivery, in which case a limited evaluation and observation for ≥48 hours is recommended 1.
• Well-appearing infants with a gestational age of 35–36 weeks whose mothers received adequate intrapartum antibiotic prophylaxis do not routinely require diagnostic evaluations 1. The approach is necessary because maternal fever increases the risk of neonatal sepsis, which can progress rapidly in newborns due to their immature immune systems, and early intervention is critical as neonatal sepsis carries significant mortality and morbidity if not promptly treated 1.

From the Research

Management of Newborns Delivered to a Febrile Mother

The management of newborns delivered to a febrile mother involves several key considerations to prevent and treat potential infections. Some of the key points to consider include:

• Antibiotic Therapy: Empirical antibiotic therapy is often initiated in newborns suspected of having sepsis, with the specific antibiotics chosen based on the suspected pathogens and local resistance patterns 2, 3.
• Group B Streptococcal Disease: Prevention of group B streptococcal disease is crucial, and this can be achieved through universal screening of pregnant women at 35-37 weeks of gestation, followed by intrapartum antibiotic prophylaxis for those who test positive 4.
• Serious Bacterial Infections: Febrile infants younger than 90 days of age are at risk of serious bacterial infections, and the choice of empirical antibiotic therapy should take into account the local epidemiology of these infections 5, 6.
• Ampicillin-Resistant Pathogens: The increasing prevalence of ampicillin-resistant pathogens, such as Escherichia coli, highlights the need for careful selection of empirical antibiotic therapy in febrile infants 5, 6.

Key Considerations for Empirical Antibiotic Therapy

Some of the key considerations for empirical antibiotic therapy in newborns delivered to a febrile mother include:

• Coverage of Gram-Negative Bacteria: The combination of ampicillin and gentamicin provides adequate coverage for most Gram-negative bacteria, including Escherichia coli 6.
• Coverage of Gram-Positive Bacteria: The addition of a Gram-positive agent, such as vancomycin, may be necessary in some cases, particularly if there is a high risk of methicillin-resistant Staphylococcus aureus (MRSA) infection.
• Local Resistance Patterns: The choice of empirical antibiotic therapy should take into account local resistance patterns, as well as the specific pathogens that are most commonly encountered in the local population 5, 6.