The Conundrum of Early-Onset Sepsis

• sepsis
• chorioamnionitis
• infection
• neonate

In an ideal world, the practice of medicine would be based on scientific studies guiding the decisions involved in the care of an individual patient. However, clinicians must frequently rely on observational studies and the experiences of other practitioners (the “art of medicine”) because high-quality randomized clinical trials are not available. Within the field of pediatrics, nowhere is that more evident than in the evaluation and treatment of infants with possible sepsis. Scientific studies have identified the risk factors for sepsis (eg, chorioamnionitis), the most frequent pathogens responsible for sepsis (group B Streptococcus and Escherichia coli), the clinical signs associated with infection, the sensitivity and specificity of diagnostic tests, and the toxicities associated with treatment.^1,2 To date, however, studies cannot accurately tell us whether an individual woman has chorioamnionitis nor whether an individual infant is infected or is instead showing clinical signs compatible with the normal transition to postnatal life or a noninfectious condition. If the treatment of sepsis were completely benign, it would make no difference if every infant with the slightest chance of infection was treated. However, …

Address correspondence to Richard A. Polin, MD, New York Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, CHC102, New York, NY 10032. E-mail: rap32{at}mail.cumc.columbia.edu