Utility of intramuscular antibiotics for secondary prevention of early onset, asymptomatic suspected neonatal sepsis

Objective:To evaluate the safety, efficacy and cost-benefit of intramuscular (IM) antibiotics administration in the secondary prevention of suspected neonatal sepsis in asymptomatic term neonates.Study Design:Retrospective review of inborn asymptomatic full-term neonates with birth weights 2000 g who required sepsis evaluation and treatment with IM antibiotics were undertaken from July 2001 to July 2008. The IM antibiotic protocol was categorized as inadequate if the neonate became symptomatic, had positive blood or cerebrospinal fluid (CSF) cultures or was readmitted for sepsis within 2 weeks of nursery discharge. Data were analyzed to identify relationships between key indicators for the presence of neonatal bacterial infection, inadequate IM antibiotics protocol and the rehospitalization rates.Result:There were 29 698 infants admitted to the newborn nursery (NBN) during the study period. A total of 5045 infants (17%) were evaluated for suspected neonatal sepsis; 421 neonates (8.3%) were treated with IM antibiotics for 48 to 72 h. Fourteen infants (3.3%) met criteria for inadequate IM antibiotics protocol. Seven infants developed symptoms within the first 32 h of life, and seven infants had positive blood or CSF cultures, one of whom required rehospitalization. None of the infants were hemodynamically unstable or developed complications, including adverse events associated with IM drug administration.Conclusion:Use of IM antibiotics is a safe alternative to intravenous antibiotics in the secondary prevention of asymptomatic term newborns with presumed sepsis. There is a substantial cost savings in caring for asymptomatic neonates with presumed sepsis in the NBN compared with neonatal intensive care unit costs.