New Insights into Prevention, Diagnosis, and Treatment of Neonatal Sepsis and Short- and Long-Term Outcomes

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 2805

Special Issue Editors


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Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
Interests: neonatology; neonatal intensive care; neonate
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Guest Editor
Department of Child Health, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
Interests: diagnosis and management of neonatal sepsis

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Guest Editor
Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45500 Ioannina, Greece
Interests: neonate; sepsis; early sepsis; late sepsis; nutrition

Special Issue Information

Dear Colleagues,

Neonatal sepsis is an important cause of neonatal morbidity and mortality. The incidence is 1 to 5 cases per 1000 live births, and it is the third most common etiology of neonatal mortality. A serious, emerging, worldwide problem is antibiotic resistance, which has been declared a global threat to public health by the Centers for Disease Control and Prevention. Microorganisms normally develop resistance against antibiotics, especially after their widespread use, by expressing resistant genes that are normally suppressed.

  • The definition of neonatal sepsis also creates challenges for effective antibiotic prescribing due to its reliance on microbiological criteria and the fact that it differs between adultand pediatric definitions. Many symptoms and clinical signs of neonatal sepsis arenon-specific and can be observed in other, more benign conditions. Because the definitionof neonatal sepsis is variable, the populations included in several clinical trials are also notwell defined, and the results of such studies can be questionable.Another difference between adults and neonates is that sepsis is diagnosed by apositive blood culture, and neonates rarely present with a focal infection. In adults, however,sepsis is usually the progression of a focal infection. Clinical criteria are often usedto diagnose neonatal sepsis rather than relying solely on blood culture results. Thesedifferences make it difficult to extrapolate research results from adult or pediatricpopulations to neonatal populations.
  • Moreover, efforts are made to define indices of neonatal sepsis with both good sensitivity and specificity, but the optimal index or even an optimal combination of indices has not been fully elucidated. Molecular diagnosis is a new, promising field.
  • Due to all these drawbacks in the diagnosis and treatment of neonatal sepsis, the prevention of this condition seems to play a crucial role. This attempt is not an easy task; hand hygiene and antibiotic stewardship are two basic strategies. Nevertheless, a bundle of preventive efforts is usually necessary to reduce the incidence of neonatal sepsis. A widely accepted standardized preventive bundle targeting multidrug-resistant organisms is lacking.
  • We are pleased to invite you to contribute to this Special Issue, which is focused on new insights, innovations, drugs, and other new strategies for the definition, diagnosis, treatment, and prevention of neonatal sepsis, which continues to be a devastating condition with high mortality and morbidity and long-term consequences.

Prof. Vasilios Giapros
Dr. Dimitrios Rallis
Dr. Maria Baltogianni
Guest Editors

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Keywords

  • neonate
  • sepsis
  • early sepsis
  • late sepsis
  • antibiotic resistance
  • multiple resistance antibiotics
  • antibiotics stewardship

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Published Papers (2 papers)

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Research

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20 pages, 478 KiB  
Article
Thromboelastometry-Based Profiling of Haemostatic Alterations in Neonatal Sepsis by Causative Pathogens
by Rozeta Sokou, Eleni A. Gounari, Konstantina A. Tsante, Aikaterini Konstantinidi, Maria Lampridou, Martha Theodoraki, Anastasios G. Kriebardis, Sotirios P. Fortis, Nicoletta Iacovidou and Andreas G. Tsantes
Antibiotics 2025, 14(1), 101; https://doi.org/10.3390/antibiotics14010101 - 17 Jan 2025
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Abstract
Background: Neonatal sepsis is a serious condition with high mortality, especially in premature and low-birth-weight neonates. This study aims to examine whether the haemostatic profile of neonates with sepsis defers depending on the type of bacteria (Gram-positive or Gram-negative), by using the [...] Read more.
Background: Neonatal sepsis is a serious condition with high mortality, especially in premature and low-birth-weight neonates. This study aims to examine whether the haemostatic profile of neonates with sepsis defers depending on the type of bacteria (Gram-positive or Gram-negative), by using the method of Rotational Thromboelastometry (ROTEM). Methods: This single-centre prospective cohort study was conducted on 128 neonates with sepsis, including 95 cases caused by Gram-negative pathogens and 33 cases caused by Gram-positive bacteria. All participants were hospitalised in the Neonatal Intensive Care Unit (NICU). ROTEM parameters were compared between neonates with Gram-positive and Gram-negative infections. Results: The ROTEM parameters were found to be significantly different between neonates suffering from Gram-positive versus Gram-negative infections, with Gram-positive pathogens associated with an increased clotting potential compared to Gram-negative pathogens. This is reflected in the higher ROTEM values such as A10, α-angle, and MCF in the EXTEM and INTEM assays. Multivariant analysis showed that Gram-positive infections were linked to increased clot thickness at 10 min (coefficient: 8.9, CI: 2.8–15.0, p = 0.004), higher maximum clot stability (coefficient: 10.4, CI: 4.3–16.6, p = 0.001), and a bigger α-angle (coefficient: 8.0, CI: 2.7–13.2, p = 0.003). Similar findings were observed in the INTEM assay parameters. Conclusions: Neonatal sepsis caused by Gram-positive bacteria leads to a hypercoagulable haemostatic state, whereas neonates with sepsis caused by Gram-negative bacteria exhibit a more hypocoagulable profile and a higher incidence of haemorrhagic episodes. These findings provide valuable insights into the haemostatic disorders associated with sepsis, and may aid in developing an individualised approach for the treatment of those disorders, dependent on and adapted for the specific type of causative organism. Full article
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21 pages, 413 KiB  
Review
Perspectives on the Use of Echinocandins in the Neonatal Intensive Care Unit
by Niki Dermitzaki, Foteini Balomenou, Dimitra Gialamprinou, Vasileios Giapros, Dimitrios Rallis and Maria Baltogianni
Antibiotics 2024, 13(12), 1209; https://doi.org/10.3390/antibiotics13121209 (registering DOI) - 12 Dec 2024
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Abstract
The neonatal intensive care unit (NICU) population, especially low birth weight and critically ill neonates, is at risk of invasive Candida infections, which are associated with high mortality rates and unfavorable long-term outcomes. The timely initiation of an appropriate antifungal treatment has been [...] Read more.
The neonatal intensive care unit (NICU) population, especially low birth weight and critically ill neonates, is at risk of invasive Candida infections, which are associated with high mortality rates and unfavorable long-term outcomes. The timely initiation of an appropriate antifungal treatment has been demonstrated to enhance the prognosis. Factors that should be considered in the choice of an antifungal agent include the causative Candida strain, the presence and location of deep tissue infection, any previous use of antifungal prophylaxis, and the presence of implanted devices. Amphotericin B and fluconazole, the first-line drugs for neonatal candidiasis, are not always suitable due to several limitations in terms of efficacy and adverse effects. Therefore, alternative antifungals have been studied and used in neonates when conventional antifungals are ineffective or contraindicated. This narrative review aims to provide an overview of the current literature regarding the use of echinocandins in the neonatal population. The three echinocandins, micafungin, caspofungin, and anidulafungin, share characteristics that make them useful for the treatment of neonatal candidiasis, including activity against a wide range of Candida strains and Candida biofilms and a favorable safety profile. Full article
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