{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:00:15Z","timestamp":1790420415044,"version":"4.1.0"},"reference-count":33,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Premature infants are at high risk of early-onset sepsis (EOS) relative to term infants, and most are administered empirical antibiotics after birth. We aimed to determine if factors evident at birth could be used to identify premature infants at lower risk of EOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Study infants were born at 22 to 28 weeks\u2019 gestation in Neonatal Research Network centers from 2006 to 2014. EOS was defined by isolation of pathogenic species from blood or cerebrospinal fluid culture at \u226472 hours age. Infants were hypothesized as \u201clow risk\u201d for EOS when delivered via cesarean delivery, with membrane rupture at delivery, and absence of clinical chorioamnionitis. Frequency of prolonged antibiotics (\u22655 days) was compared between low-risk infants and all others. Risks of mortality, EOS, and other morbidities were assessed by using regression models adjusted for center, race, antenatal steroid use, multiple birth, sex, gestation, and birth weight.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Of 15\u2009433 infants, 5759 (37%) met low-risk criteria. EOS incidence among infants surviving &amp;gt;12 hours was 29 out of 5640 (0.5%) in the low-risk group versus 209 out of 8422 (2.5%) in the comparison group (adjusted relative risk = 0.24 [95% confidence interval, 0.16\u20130.36]). Low-risk infants also had significantly lower combined risk of EOS or death \u226412 hours. Prolonged antibiotics were administered to 34% of low-risk infants versus 47% of comparison infants without EOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Delivery characteristics of extremely preterm infants can be used to identify those with significantly lower incidence of EOS. Recognition of differential risk may help guide decisions to limit early antibiotic use among approximately one-third of these infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2017-0925","type":"journal-article","created":{"date-parts":[[2017,10,5]],"date-time":"2017-10-05T05:10:18Z","timestamp":1507180218000},"source":"Crossref","is-referenced-by-count":102,"title":["Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis"],"prefix":"10.1542","volume":"140","author":[{"given":"Karen M.","family":"Puopolo","sequence":"first","affiliation":[{"name":"Division of Neonatology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania\u037e"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagori","family":"Mukhopadhyay","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania\u037e"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nellie I.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina\u037e"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Michael","family":"Cotten","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Duke University Medical Center, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara J.","family":"Stoll","sequence":"additional","affiliation":[{"name":"McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo J.","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Section of Neonatology, Nationwide Children\u2019s Hospital, The Ohio State University, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward F.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Iowa, Iowa City, Iowa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhik","family":"Das","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology Division, RTI International, Rockville, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelita M.","family":"Hensman","sequence":"additional","affiliation":[{"name":"Warren Alpert Medical School, Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisa P.","family":"Van Meurs","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, Stanford University, Stanford, California;"},{"name":"Lucile Packard Children\u2019s Hospital, Palo Alto, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myra H.","family":"Wyckoff","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, and Children\u2019s Medical Center Dallas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the NICHD Neonatal Research Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2017,11,1]]},"reference":[{"issue":"6","key":"2021121015021580500_B1","doi-asserted-by":"crossref","first-page":"e20162013","DOI":"10.1542\/peds.2016-2013","article-title":"Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014.","volume":"138","author":"Schrag","year":"2016","journal-title":"Pediatrics"},{"issue":"5","key":"2021121015021580500_B2","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1542\/peds.2010-2217","article-title":"Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues.","volume":"127","author":"Stoll","year":"2011","journal-title":"Pediatrics"},{"issue":"1","key":"2021121015021580500_B3","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1542\/peds.2007-3423","article-title":"Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants.","volume":"123","author":"Cotten","year":"2009","journal-title":"Pediatrics"},{"issue":"9","key":"2021121015021580500_B4","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1086\/502270","article-title":"Duration of empiric antibiotics for suspected early-onset sepsis in extremely low birth weight infants.","volume":"24","author":"Cordero","year":"2003","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"5","key":"2021121015021580500_B5","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1542\/peds.2014-3409","article-title":"Neonatal intensive care unit antibiotic use.","volume":"135","author":"Schulman","year":"2015","journal-title":"Pediatrics"},{"issue":"3","key":"2021121015021580500_B6","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jpeds.2011.02.035","article-title":"Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis.","volume":"159","author":"Alexander","year":"2011","journal-title":"J Pediatr"},{"issue":"5","key":"2021121015021580500_B7","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.jpeds.2011.05.033","article-title":"Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants.","volume":"159","author":"Kuppala","year":"2011","journal-title":"J Pediatr"},{"issue":"4","key":"2021121015021580500_B8","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2009-3412","article-title":"Neonatal candidiasis: epidemiology, risk factors, and clinical judgment.","volume":"126","author":"Benjamin","year":"2010","journal-title":"Pediatrics"},{"issue":"12","key":"2021121015021580500_B9","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1001\/jamapediatrics.2016.2132","article-title":"Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis.","volume":"170","author":"Ting","year":"2016","journal-title":"JAMA Pediatr"},{"issue":"6","key":"2021121015021580500_B10","first-page":"714","article-title":"Routes and types of infection in the fetus and the newborn.","volume":"99","author":"Benirschke","year":"1960","journal-title":"AMA J Dis Child"},{"issue":"6","key":"2021121015021580500_B11","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/S0022-3476(73)80524-4","article-title":"Transmission of group B streptococci among parturient women and their neonates.","volume":"83","author":"Baker","year":"1973","journal-title":"J Pediatr"},{"issue":"6","key":"2021121015021580500_B12","article-title":"Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review.","volume":"103","author":"Benitz","year":"1999","journal-title":"Pediatrics"},{"issue":"4","key":"2021121015021580500_B13","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1056\/NEJMoa020205","article-title":"A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates.","volume":"347","author":"Schrag","year":"2002","journal-title":"N Engl J Med"},{"issue":"6","key":"2021121015021580500_B14","doi-asserted-by":"crossref","first-page":"642","DOI":"10.3109\/14767058.2011.597899","article-title":"Preterm birth aetiology 2004-2008. 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