{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T16:35:50Z","timestamp":1776357350792,"version":"3.51.2"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T00:00:00Z","timestamp":1681344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Regione Emilia-Romagna","award":["E43C22000530002"],"award-info":[{"award-number":["E43C22000530002"]}]},{"name":"Regione Emilia-Romagna","award":["RIA2018V-2304"],"award-info":[{"award-number":["RIA2018V-2304"]}]},{"name":"The International PREPARE Project","award":["E43C22000530002"],"award-info":[{"award-number":["E43C22000530002"]}]},{"name":"The International PREPARE Project","award":["RIA2018V-2304"],"award-info":[{"award-number":["RIA2018V-2304"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>The effectiveness of \u201cinadequate\u201d intrapartum antibiotic prophylaxis (IAP administered &lt; 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003\u20132022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and E. coli culture-confirmed EOS cases. IAP was defined \u201cactive\u201d when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an \u201cinactive\u201d IAP (52%) developed symptoms from 1 to &gt;48 h of life. The key element to define IAP \u201cadequate\u201d seems the pathogen\u2019s antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond.<\/jats:p>","DOI":"10.3390\/pathogens12040588","type":"journal-article","created":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T04:33:26Z","timestamp":1681360406000},"page":"588","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3534-7499","authenticated-orcid":false,"given":"Alberto","family":"Berardi","sequence":"first","affiliation":[{"name":"Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5224-8073","authenticated-orcid":false,"given":"Viola","family":"Trevisani","sequence":"additional","affiliation":[{"name":"School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7951-5717","authenticated-orcid":false,"given":"Antonella","family":"Di Caprio","sequence":"additional","affiliation":[{"name":"School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Caccamo","sequence":"additional","affiliation":[{"name":"School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Latorre","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabrina","family":"Loprieno","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Foglianese","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4610-1216","authenticated-orcid":false,"given":"Nicola","family":"Laforgia","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari \u201cAldo Moro\u201d, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Perrone","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, 60126 Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4259-4540","authenticated-orcid":false,"given":"Giangiacomo","family":"Nicolini","sequence":"additional","affiliation":[{"name":"Pediatric Unit, San Martino Hospital, 32100 Belluno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilde","family":"Ciccia","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Women\u2019s and Children\u2019s Health Department, Maggiore Hospital, 40133 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Capretti","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Women\u2019s and Children\u2019s Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Giugno","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittoria","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Bufalini Hospital, Cesena, 47521 Cesena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Merazzi","sequence":"additional","affiliation":[{"name":"Division of Neonatology, \u201cValduce\u201d Hospital, 22100 Como, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Fanaro","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Taurino","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita Maria","family":"Pulvirenti","sequence":"additional","affiliation":[{"name":"Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forl\u00ec, 47121 Forl\u00ec, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Orlandini","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9820-6557","authenticated-orcid":false,"given":"Cinzia","family":"Auriti","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, \u201cBambino Ges\u00f9\u201d Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Haass","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Ligi","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Vellani","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chryssoula","family":"Tzialla","sequence":"additional","affiliation":[{"name":"Neonatal and Pediatric Unit, Polo Ospedaliero Oltrep\u00f2, ASST Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Tuoni","sequence":"additional","affiliation":[{"name":"Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, 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Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Visintini","sequence":"additional","affiliation":[{"name":"Neonatology Unit, University Hospital of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lidia","family":"Decembrino","sequence":"additional","affiliation":[{"name":"ASST Pavia, Unit\u00e0 Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4290-9039","authenticated-orcid":false,"given":"Roberta","family":"Creti","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5991-8949","authenticated-orcid":false,"given":"Francesca","family":"Miselli","sequence":"additional","affiliation":[{"name":"Neonatal Intensive 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