LAUSR

Intervention: Infants that met inclusion criteria were observed in the mother–infant unit. An initial blood culture, complete blood count with manual differential (CBC), and high-sensitivity C-reactive protein (hsCRP) were obtained at 0–6 h of life. A repeat CBC and hsCRP were obtained at 12–24 h of life, and 24–48 h of life. Asymptomatic infants were considered to have positive laboratory results with any of the following at any time point: a white blood cell (WBC) count of < 5000 mm or > 30,000 mm, band counts of > 24%, hsCRP of > 10 mg/L, or a positive blood culture. Infants were transferred to the NICU and treated with antibiotics following any positive laboratory result or concern for the development of clinical signs of infection based on exam and vital signs monitored every 4 h. Main results: Two hundred and forty infants met inclusion criteria and were admitted to the mother–infant unit. One hundred and sixty-two infants (67.5%) were able to stay in the mother–infant unit without antibiotic treatment, whereas 78 (32.5%) required NICU admission and were treated with antibiotics. Of these 78 admissions, 12 infants had true positive blood cultures, only two of which exhibited clinical signs of infection. The remaining 10 bacteremic infants were admitted owing to positive blood cultures as the only sign of bacteremia. The majority of mothers with bacteremic infants (75%) did not receive antibiotics > 4 h prior to delivery. Factors that were associated with NICU admission were higher maternal maximum temperature (p= 0.04) and a placenta confirming histologic chorioamnionitis (p= 0.01). There were no laboratory differences outside of blood culture distinguishing infants with bacteremia. Median antibiotic treatment once admitted to the NICU was 7 days. There were no infant deaths or readmissions for sepsis in any of the study patients.