What is the mortality risk for a newborn meeting Systemic Inflammatory Response Syndrome (SIRS) criteria who is not treated with antibiotics due to parental refusal?

From the Guidelines

A newborn meeting SIRS criteria who does not receive antibiotics faces a significant risk of death, potentially 10-30% or higher depending on the underlying cause. SIRS in newborns indicates a serious systemic inflammation that may signal sepsis, which can rapidly progress to septic shock and multiple organ failure. The standard of care for these infants is immediate antibiotic therapy, typically with ampicillin (50-100 mg/kg/dose) and gentamicin (4-5 mg/kg/dose) or another appropriate combination based on local resistance patterns, as suggested by guidelines for managing at-risk infants 1.

Key Considerations

• The risk of early-onset infection is reduced by 60% to 70% in term infants with a good clinical condition at birth, but antibiotics should be administered to infants who are ill at birth or develop signs of illness during the first 48 hours after delivery 1.
• Preterm infants, especially those born before 35 weeks’ gestation due to certain indications like cervical insufficiency or preterm labor, are at a higher risk of early-onset sepsis and should receive empiric antibiotics 1.
• Parents refusing antibiotics should be thoroughly counseled about the high mortality risk of untreated neonatal sepsis, the safety profile of antibiotics, and the time-sensitive nature of treatment.

Management Approach

• Immediate initiation of antibiotic therapy is crucial for newborns meeting SIRS criteria, with the goal of starting treatment within one hour of recognition.
• The choice of antibiotics should be based on local resistance patterns and may include ampicillin and gentamicin or other appropriate combinations.
• Treatment should continue until cultures are negative for at least 48-72 hours or a full course is completed if infection is confirmed.
• Medical teams may need to consider legal interventions to protect the infant if parents continue to refuse life-saving treatment, as the child's right to receive necessary medical care typically overrides parental refusal in immediately life-threatening situations.

From the Research

Newborn Meeting SIRS Criteria and Refusing Antibiotics

• The likelihood of a newborn dying after meeting SIRS criteria and the parents refusing antibiotics is not directly stated in the provided studies.
• However, studies have shown that sepsis and SIRS can have severe consequences for newborns, including morbidity and mortality 2.
• The applicability of SIRS and sepsis definitions to neonates has been examined in several studies, with varying results 3, 4.
• One study found that the definitions of SIRS and sepsis did not apply to about half of all cases of culture-proven early-onset sepsis 3.
• Another study found that the sensitivity of SIRS and sepsis definitions was higher in preterm compared to term newborns in cases of culture-proven and clinical early-onset sepsis 4.
• The risk of hearing loss in neonatal intensive care unit (NICU) graduates has been linked to sepsis and systemic inflammatory response syndrome, as well as exposure to gentamicin 5.
• The traditional definition of sepsis requires the presence of at least two SIRS criteria in addition to a suspected or proven infection, but this definition may exclude some patients with severe sepsis 6.

Mortality Risk

• The mortality risk for a newborn meeting SIRS criteria and refusing antibiotics is not explicitly stated in the provided studies.
• However, it is known that sepsis and SIRS can have severe consequences for newborns, including increased risk of morbidity and mortality 2, 3, 4.
• The decision to refuse antibiotics should be made with caution and under the guidance of a qualified healthcare professional, as it may impact the newborn's outcome.