Interventions for reducing late-onset sepsis in neonates: an umbrella review

Abdul Razak; Omar Ibrahim Alhaidari; Javed Ahmed

doi:10.1515/jpm-2022-0131

Interventions for reducing late-onset sepsis in neonates: an umbrella review

J Perinat Med. 2022 Oct 31;51(3):403-422. doi: 10.1515/jpm-2022-0131. Print 2023 Mar 28.

Authors

Abdul Razak^{1

2}, Omar Ibrahim Alhaidari^{2

3}, Javed Ahmed³

Affiliations

¹ Monash Newborn, Monash Children's Hospital, Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia.
² Division of Neonatology, Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
³ Department of Pediatrics, McMaster Children's Hospital, McMaster University, ON, Canada.

PMID: 36303465
DOI: 10.1515/jpm-2022-0131

Abstract

Objectives: Neonatal sepsis is one of the leading causes of neonatal deaths in neonatal intensive care units. Hence, it is essential to review the evidence from systematic reviews on interventions for reducing late-onset sepsis (LOS) in neonates.

Methods: PubMed and the Cochrane Central were searched from inception through August 2020 without any language restriction. Cochrane reviews of randomized clinical trials (RCTs) assessing any intervention in the neonatal period and including one or more RCTs reporting LOS. Two authors independently performed screening, data extraction, assessed the quality of evidence using Cochrane Grading of Recommendations Assessment, Development and Evaluation, and assessed the quality of reviews using a measurement tool to assess of multiple systematic reviews 2 tool.

Results: A total of 101 high-quality Cochrane reviews involving 612 RCTs and 193,713 neonates, evaluating 141 interventions were included. High-quality evidence showed a reduction in any or culture-proven LOS using antibiotic lock therapy for neonates with central venous catheters (CVC). Moderate-quality evidence showed a decrease in any LOS with antibiotic prophylaxis or vancomycin prophylaxis for neonates with CVC, chlorhexidine for skin or cord care, and kangaroo care for low birth weight babies. Similarly, moderate-quality evidence showed reduced culture-proven LOS with intravenous immunoglobulin prophylaxis for preterm infants and probiotic supplementation for very low birth weight (VLBW) infants. Lastly, moderate-quality evidence showed a reduction in fungal LOS with the use of systemic antifungal prophylaxis in VLBW infants.

Conclusions: The overview summarizes the evidence from the Cochrane reviews assessing interventions for reducing LOS in neonates, and can be utilized by clinicians, researchers, policymakers, and consumers for decision-making and translating evidence into clinical practice.

Keywords: infection; late-onset sepsis; neonatal sepsis; neonate; overview; sepsis.

Publication types

Review

MeSH terms

Chlorhexidine
Humans
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Probiotics*
Randomized Controlled Trials as Topic
Sepsis* / prevention & control
Systematic Reviews as Topic

Substances

Chlorhexidine