The “Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals” protocol adopts the following definition of Specific Neonatal Case definitions (NEO).

 

NEO-CSEP: clinical sepsis in neonates.

All of the three following criteria:

  • supervising physician started appropriate antimicrobial therapy for sepsis for at least five days;
  • no detection of pathogens in blood culture or not tested;
  • no obvious infection at another site;

and two of the following criteria (without other apparent cause):

    • fever (> 38 °C) or temperature instability (frequent post-set of the incubator) or hypothermia (< 36.5 °C);
    • tachycardia (> 200/min) or new /increased bradycardia (< 80/min);
    • capillary refilling time (CRT) > 2s;
    • new or increased apnoea(s) (> 20s);
    • unexplained metabolic acidosis;
    • new-onset hyperglycemia (> 140mg/dl);
    • another sign of sepsis (skin colour (only if the CRT is not used), laboratory signs (CRP, interleukin), increased oxygen requirement (intubation), unstable general condition of the patient, apathy).

A one-time detection of coagulase-negative staphylococci (CNS) in blood cultures should not exclude the diagnosis of clinical sepsis. A clinical sepsis can also be diagnosed with a single positive blood culture with CNS, which is considered as a blood culture contamination, while other criteria of CNS bloodstream infection are not met and criteria of clinical sepsis have been met.

 

NEO-LCBI: laboratory-confirmed BSI.

  • At least two of: temperature > 38 °C or < 36.5 °C or temperature instability, tachycardia or bradycardia, apnoea, extended capillary refilling time (CRT), metabolic acidosis, hyperglycaemia, other sign of BSI such as apathy;

and

a recognised pathogen other than coagulase-negative staphylococci (CNS) cultured from blood or cerebrospinal fluid (CSF; this is included because meningitis in this age group is usually haematogenous, so positive CSF can be regarded as evidence of BSI even if blood cultures are negative or were not taken).

Further instructions for reporting:

  • origin of the neonatal BSI must be reported in the field BSI origin;
  • If both the case definitions for NEO-LCBI and NEO-CNSB are matched, it must be reported as NEO-LCBI.

 

NEO-CNSB: laboratory-confirmed BSI with coagulase-negative staphylococci.

  • At least two of: temperature > 38 °C or < 36.5 °C or temperature instability, tachycardia or bradycardia, apnoea, extended recapillarisation time, metabolic acidosis, hyperglycaemia, other sign of BSI such as apathy;

and

CNS is cultured from blood or catheter tip;

and

  • patient has one of: C-reactive protein > 2.0 mg/dL, immature/total neutrophil ratio (I/T ratio) > 0.2, leukocytes < 5/nL, platelets <100/nL.

Further instructions for reporting:

  • origin of the neonatal BSI must be reported in the field BSI origin;
  • If both the case definitions for NEO-LCBI and NEO-CNSB are matched, it must be reported as NEO-LCBI.

 

NEO-PNEU: pneumonia.

  • Respiratory compromise,

and

new infiltrate, consolidation or pleural effusion on chest x-ray;

and at least four of:

temperature> 38 °C or < 36.5 °C or temperature instability, tachycardia or bradycardia, tachypnoea or apnoea, dyspnoea, increased respiratory secretions, new onset of purulent sputum, isolation of a pathogen from respiratory secretions, C-reactive protein > 2.0 mg/dL, I/T ratio > 0.2.

 

NEO-NEC: necrotising enterocolitis.

  • Histopathological evidence of necrotising enterocolitis;

or at least one characteristic radiographic abnormality (pneumoperitoneum, pneumatosis intestinalis, unchanging ‘rigid’ loops of small bowel)

plus at least two of the following without other explanation:

vomiting, abdominal distention, prefeeding residuals, persistent microscopic or gross blood in stools.

 

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Link to European IC/HH Core Competencies

Area 3. Surveillance and investigation of healthcare associated infection (HAI)

References

http://www.ecdc.europa.eu/en/publications/Publications/0512-TED-PPS-HAI-antimicrobial-use-protocol.pdf