Ammara Mushtaq, Momina Abid, Muhammad Asif Qureshi.
Is prophylactic antibiotic treatment justified in neonates?.
J Pak Med Assoc Jan ;62(8):856-7.

Infections are second leading cause of mortality preceded only by cardiovascular diseases.1 Neonates in particular are at a high-risk of developing bloodstream infections because of their immature immune system and mucosal surfaces.2,3 In neonates, sepsis has repeatedly been indicated to be an important cause of mortality, with preterm and very low birth weight (<1500g) infants being at the highest risk.3 Nosocomial bloodstream infections, are vital reasons for neonatal morbidity and mortality. According to a study 64% were caused due to gram- positive organisms, 27% due to gram negative organisms and 8% due to fungi, the most common of the infectious agents being the coagulase negative staphylococci.4 The first microbial colonization in a newborn occurs during the passage through the birth canal and therefore the empiric treatment for early onset sepsis is based on the most common organisms detected at birth and that of late onset sepsis depends on presenting clinical signs.5 Factors that specifically increase neonatal susceptibility to infections include maternal fever during delivery, premature rupture of membranes, preterm labour and maternal urinary and genital tracts colonization.3,6 Clinical signs of sepsis include "temperature instability, respiratory distress, vomiting, abdominal distension, poor feeding, lethargy or irritability, hypotension, tachycardia, pallor, petechiae, cyanosis and jaundice."6 It is a common practice amongst paediatricians to administer antibiotics to at risk neonates, without evidence of clinically or microbiologically proven sepsis.6 The choice between prophylactic versus selective antibiotics in newborns at risk of sepsis still remains a dilemma in paediatric medicine. The American Academy of Pediatrics in 1997 recommended prophylactic antibiotic treatment of all at-risk infants whereas Lopez in 2001 recommended against it.6 Currently, the practices vary widely depending on hospital settings as there\'s insufficient data from randomized controlled trials to guide practice.

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