Neonatal intensive care (NICU) research at CPCE aims to improve the evaluation of neonatal infection risk and to establish appropriate stewardship of antibiotic use.
Over 500,000 newborns are evaluated for risk of neonatal early-onset sepsis (EOS) in the United States each year, with the vast majority ultimately found to be entirely healthy. The most common indication for newborn medical intervention at birth, EOS can significantly impact mother-infant bonding, newborn provider care utilization, and cost of newborn care. Exposure to broad spectrum antibiotics before delivery and within hours of birth can also cause the immune system not to develop to its full potential.
Although the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) published guidelines for EOS evaluation, they did not quantify their clinical impact. Through several published studies, we were the first to describe the very high proportion of infants undergoing EOS evaluation, the associated economic costs, and the negative effect on breastfeeding. Our research has helped spark a national debate about the relative merits of EOS evaluation, particularly among low-risk, well-appearing full-term infants.
- In a study published in Pediatrics, CPCE researchers developed and validated a Sepsis Risk Score to estimate individual infant risk and to guide care decisions. This individual risk assessment approach is being incorporated into daily newborn care and has the potential to radically transform the national approach to this increasingly rare but potentially life-threatening condition.
- More recently, our research demonstrated that the most predictive information for assessing EOS can be obtained from combining components of the complete blood count (CBC), the most common lab test currently used for this purpose.
- A study we published in Hospital Pediatrics found a significant decline in breastfeeding when infants were evaluated for EOS, highlighting the importance of utilizing methods that safely minimize medical intervention.
What’s Next: CPCE researchers are actively working to validate a new prediction model for EOS and plan to investigate the long-term impact of using broad-spectrum antibiotics before delivery or within hours of birth.
Funding: National Institutes of Health (NIH); Harvard Clinical and Translational Science Center
Please contact Karen M. Puopolo, MD, PhD, attending neonatologist and section chief for CHOP Newborn Care at Pennsylvania Hospital, for more information about this line of research.
Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, Newman TB, Zupancic J, Lieberman E, Draper D. Stratification of Risk of Early-onset Sepsis in Newborns ≥ 34 Weeks' Gestation. Pediatrics. 2014 Jan;133(1):30-6.
Mukhopadhyay S, Eichenwald EC, Puopolo KM. Neonatal Early-onset Sepsis Evaluations Among Well-appearing Infants: Projected impact of changes in CDC GBS guidelines. J Perinatol. 2013 Mar;33 (3):198-205.
Mukhopadhyay S, Dukhovny D, Mao W, Eichenwald EC, Puopolo KM. 2010 Perinatal GBS Prevention Guideline and Resource Utilization. Pediatrics. 2014 Feb;133(2):196-203.
Mukhopadhyay S, Puopolo KM. Risk Assessment in Neonatal Early Onset Sepsis. Semin Perinatol. 2012 Dec;36(6):408-15.
Mukhopadhyay S, Puopolo KM. Neonatal Early-Onset Sepsis: Epidemiology and Risk Assessment. NeoReviews. 2015 Apr;16(4):221-230.
Mukhopadhyay S, Lieberman ES, Puopolo KM, Riley LE, Johnson LC. Effect of Early-onset Sepsis Evaluations on In-hospital Breastfeeding Practices Among Asymptomatic Term Neonates. Hosp Pediatr. 2015 Apr;5(4):203-10.
Newman TB, Puopolo KM, Wi S, Draper D, Escobar GJ. Interpreting Complete Blood Counts Soon After Birth in Newborns at Risk for Sepsis. Pediatrics. 2010 Nov;126(5):903-9.
Newman TB, Draper D, Puopolo KM, Wi S, Escobar GJ. Combining Immature and Total Neutrophil Counts to Predict Early Onset Sepsis in Term and Late Preterm Newborns: Use of the I/T2. Pediatr Infect Dis J. 2014 Aug;33(8):798-802.
Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, Smith M, Escobar GJ. Estimating the Probability of Neonatal Early-onset Infection on the Basis of Maternal Risk Factors. Pediatrics. 2011 Nov;128(5):e1155-63.