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Challenges in developing a consensus definition of neonatal sepsis

Pediatric Research volume 88, pages 14–26 (2020)Cite this article

Abstract

Sepsis remains a leading cause of morbidity and mortality in the neonatal population, and at present, there is no unified definition of neonatal sepsis. Existing consensus sepsis definitions within paediatrics are not suited for use in the NICU and do not address sepsis in the premature population. Many neonatal research and surveillance networks have criteria for the definition of sepsis within their publications though these vary greatly and there is typically a heavy emphasis on microbiological culture. The concept of organ dysfunction as a diagnostic criterion for sepsis is rarely considered in neonatal literature, and it remains unclear how to most accurately screen neonates for organ dysfunction. Accurately defining and screening for sepsis is important for clinical management, health service design and future research. The progress made by the Sepsis-3 group provides a roadmap of how definitions and screening criteria may be developed. Similar initiatives in neonatology are likely to be more challenging and would need to account for the unique presentation of sepsis in term and premature neonates. The outputs of similar consensus work within neonatology should be twofold: a validated definition of neonatal sepsis and screening criteria to identify at-risk patients earlier in their clinical course.

Impact

  • There is currently no consensus definition of neonatal sepsis and the definitions that are currently in use are varied.

  • A consensus definition of neonatal sepsis would benefit clinicians, patients and researchers.

  • Recent progress in adults with publication of Sepsis-3 provides guidance on how a consensus definition and screening criteria for sepsis could be produced in neonatology.

  • We discuss common themes and potential shortcomings in sepsis definitions within neonatology.

  • We highlight the need for a consensus definition of neonatal sepsis and the challenges that this task poses.

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Acknowledgements

This research was funded in part by the National Children’s Research Centre, Dublin, Ireland. E.G. is supported by the Leenaards Foundation and E.J.M. by the Health Research Board of Ireland.

Author information

Affiliations

  1. Paediatrics, Academic Centre, Tallaght University Hospital, Trinity College, the University of Dublin, Dublin, Ireland

    Matthew McGovern & Eleanor J. Molloy

  2. Trinity Translational Medicine Institute, St James’ Hospital, Dublin, Ireland

    Matthew McGovern & Eleanor J. Molloy

  3. Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Eric Giannoni

  4. Neonatology, Clinic for Paediatric Cardiology and Intensive Care, University Medical Centre Göttingen, Göttingen, Germany

    Helmut Kuester

  5. Institute of Translational Medicine, University of Liverpool (a member of Liverpool Health Partners), Centre for Women’s Health Research, Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS, UK

    Mark A. Turner

  6. Division Woman and Baby, Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands

    Agnes van den Hoogen

  7. Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA

    Joseph M. Bliss

  8. Division of Neonatology, Saint Louis University, Edward Doisy Research Center, 1100 S. Grand Boulevard, St. Louis, MO, 63104, USA

    Joyce M. Koenig

  9. Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands

    Fleur M. Keij, Sinno H. P. Simons & Irwin K. M. Reiss

  10. Department of Neonatology and Infectious Diseases, Poznan University of Medical Sciences, ul. Polna 33, 60535, Poznan, Poland

    Jan Mazela

  11. Neonatology, Coombe Women and Infants’ University Hospital, Dublin, Ireland

    Rebecca Finnegan & Eleanor J. Molloy

  12. Neonatology, Pirogov Russian National Research Medical University, Moscow, Russia

    Marina Degtyareva

  13. Radboud Institute for Health Sciences, Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, The Netherlands

    Willem P. de Boode

  14. Neonatal Health and Development, Telethon Kids Institute, Perth, WA, Australia

    Tobias Strunk

  15. Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, WA, Australia

    Tobias Strunk

  16. Department of Paediatrics, University of Florida, Gainesville, FL, USA

    James L. Wynn

  17. Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland

    Eleanor J. Molloy

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  1. Matthew McGovern
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  2. Eric Giannoni
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  3. Helmut Kuester
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  15. Irwin K. M. Reiss
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  17. Eleanor J. Molloy
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on behalf of the Infection, Inflammation, Immunology and Immunisation (I4) section of the ESPR

Contributions

M.M. and E.J.M.: Manuscript conception and design, literature review and manuscript revision, and revised and edited the manuscript before submission. E.G., H.K., M.A.T., A.v.d.H., J.M.B., J.M.K., F.M.K., J.M., R.F., M.D., S.H.P.S., W.P.d.B., T.S., I.K.M.R., and J.L.W.: Significant contributions to the intellectual content and literature review of the manuscript and revised and the edited manuscript before submission.

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Correspondence to Eleanor J. Molloy.

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McGovern, M., Giannoni, E., Kuester, H. et al. Challenges in developing a consensus definition of neonatal sepsis. Pediatr Res 88, 14–26 (2020). https://doi.org/10.1038/s41390-020-0785-x

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