LAUSR

OVERVIEW OF NEONATAL SEPSIS AND DEFINITIONS Sepsis represents a major contributor to global mortality and has been declared as a priority by the WHO. The highest sepsis incidence across all age groups is found in neonates affecting an estimated 3 million babies worldwide (22 per 1000 live births) with a mortality of 11–19% and unquantified long-term neurological defects. However, international data are difficult to standardise in the absence of unified criteria for neonatal sepsis. Recently, in adults, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) have defined sepsis as a life-threatening organ dysfunction caused by a dysregulated response to infection. The new consensus definition moved away from the concept of systemic inflammatory response syndrome, which formed part of the definition of sepsis in the past 20 years. Sepsis-3 criteria were developed and validated on large cohorts of electronic health record data-derived episodes from adults with sepsis. Despite the clear merits of the approach chosen by the Sepsis-3 taskforce, there are several pitfalls towards the translation of Sepsis-3 to neonates. The criteria to define infection and sepsis are essential in the neonatal population to limit overdiagnosis, but they are not part of the adult Sepsis-3 definitions. Sepsis-3 is based only on short-term outcomes but in neonates integration of predictors of long-term disability is critical. The criteria for organ dysfunction according to gestational and postnatal age need to be defined through systematic reviews and retrospective studies and validated in prospective studies. The Sequential Organ Failure Assessment Score (SOFA) reflects changes in organ function altering from baseline. The pSOFA has been proposed and was found to be a reliable predictor of inhospital mortality in children. The recently described neonatal SOFA (nSOFA) predicted mortality on Very Low Birth Weight (VLBW) infants with late onset sepsis. In this issue of the journal an international group has provided an overview of the diverse definitions of neonatal sepsis with the aim of working towards international consensus.