#12 Neonatal Sepsis
Guest: Con Yee Ling, MD, FAAP
December 2019
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Show Notes
Disclosures
No commercial support is associated with this CME activity.
Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities
The AAP CME/CPD program develops, maintains, and improves the competence, skills, and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice. The AAP CME/CPD program strives to meet the educational needs of pediatricians and pediatric healthcare professionals and support their lifelong learning with a goal of improving care for children and families. (AAP CME/CPD Program Mission Statement, May 2015)
The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest.
All AAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.
The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in CME activities. Listed below are the disclosures provided by individuals in a position to influence and/or control CME activity content.
* A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Disclosure of Commercial Support for AAP CME Activities
No commercial support is associated with this CME activity.
Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities
The AAP CME/CPD program develops, maintains, and improves the competence, skills, and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice. The AAP CME/CPD program strives to meet the educational needs of pediatricians and pediatric healthcare professionals and support their lifelong learning with a goal of improving care for children and families. (AAP CME/CPD Program Mission Statement, May 2015)
The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest.
All AAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.
The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in CME activities. Listed below are the disclosures provided by individuals in a position to influence and/or control CME activity content.
* A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
| Name | Role |
Relevant Financial Relationship (Please indicate Yes or No) |
Name of Commercial Interest(s)* Please list name(s) of entity AND Nature of Relevant Financial Relationship(s) (Please list: Research Grant, Speaker’s Bureau, Stock/Bonds excluding mutual funds, Consultant, Other – identify) |
Disclosure of Off-Label (Unapproved)/Investigational Uses of Products (Do intend to discuss or Do not intend to discuss) |
| Paul Wirkus | Planner/Moderator | NO | NONE | Do not intend to discuss |
| Con Yee Ling | Faculty | NO | NONE | Do not intend to discuss |
| Carolyn Reynolds | Planner | NO | NONE | Do not intend to discuss |
| Alison M. Barrington | Planner | NO | NONE | Do not intend to discuss |
| Brooke Hall | Planner | NO | NONE | Do not intend to discuss |
| Alisa Stoddard | UTAAP Staff/COI Reviewer-Resolver | NO | NONE | Do not intend to discuss |
Accreditation
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Academy of Pediatrics (AAP) and the Utah Chapter of the AAP. The American Academy of Pediatrics is accredited by the ACCME to provide continuing medical education for physicians.
The AAP designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity is acceptable for a maximum of 1.0 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.
PAs may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.
This program is accredited for 1.0 NAPNAP CE contact hours of which 0 contain pharmacology (Rx) content, (0 related to psychopharmacology) (0 related to controlled substances), per the National Association of Pediatric Nurse Practitioners (NAPNAP) Continuing Education Guidelines.
MOC Statement:
Successful completion of this CME activity, which includes participation in the activity and individual assessment of and feedback to the learner, enables the learner to earn up to 1.0 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.
If you do not successfully complete all components of the activity and evaluation assessment ABP MOC Part 2 Points will not be awarded.
Please note: your completion data will be shared with the ABP through the ACCME PARS system within 30 days of successful completion. This will include the name of the activity and provider; participant name; participant’s ABP ID number; participant’s DOB; date of completion of the activity; the PARS activity identifier; ABP MOC Part 2 credit statement and number of MOC points awarded. If any questions or concerns please contact the activity manager alisa@aaputah.org.
Guest: Con Yee Ling, MD, FAAP
Quiz available after 4th episode airs, typically the fourth week of the month.
Virtual Curbside Podcast – Neonatal Sepsis
Dates valid for credit: February 1, 2020 – October 31, 2022
Claim for Credit
- Learners who complete the activity are eligible for 1.0 AMA PRA Category 1 Credit TM.
- Learners who complete all quiz questions, and who meet the 50% minimum passing score requirements, will be eligible for 1.0 MOC Part 2 points.
Learning Objectives
After listening to these episodes listeners will…
- Be able to define sepsis
- Be aware of the guidelines
- Be aware of the NEW guidelines and antibiotic stewardship
Time Stamps Episode 12-1
Intro
3:07 Early onset sepsis in neonates
5:04 What makes sepsis sepsis?
6:05 How do you differentiate sepsis in pediatrics and adults?
9:53 What are the challenges in septic newborns?
12:12 How does a newborn become infected?
12:51 What is the microbiology of neonatal sepsis?
16:10 Do preventative measures make a difference?
18:08 How does sepsis evolve?
Outro
Time Stamps Episode 12-2
Intro
1:50 Group B Strep
3:36 How long have we have guidelines?
5:55 Screen or risk-based approach?
9:00 Refined guidelines
12:37 2017 Revisions
Time Stamps Episode 12-3
Intro
00:56 New guidelines
6:03 ACOG recommendations
8:33 Resistance patterns
10:26 Diagnosing early-onset sepsis
15:32 Changes in calculator
21:25 Ongoing assessment
Links from the Show
EOS Calculator – in order of most recent publication
- Achten, N., Klingenberg, C., Benitz, W., Stocker, M., Schlapbach, L., Giannoni, E., ….Plötz, F. (2019). Association of Use of the Neonatal Early-Onset Sepsis Calculator with Reduction in Antibiotic Therapy and Safety: A Systematic Review and Meta-analysis. JAMA Pediatrics,173(11), 1032-1040. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2748691
- Puopolo, K., & Escobar, G. (2019). Neonatal Sepsis Evaluation: Facing the Certainty of Uncertainty. JAMA Pediatrics,173(11), 1015-1016.
- Kuzniewicz, M., Puopolo, K., & Fischer, A. (2017). A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatrics,171(4), 365-371.
Link to PubMed citation: https://www.ncbi.nlm.nih.gov/pubmed/28241253
Link to full-text article: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2604260
- Kuzniewicz, M., Walsh, E., Li, S., Fischer, A., & Escobar, G. (2016). Development and Implementation of an Early-Onset Sepsis Calculator to Guide Antibiotic Management in Late Preterm and Term Neonates. Joint Commission Journal on Quality and Patient Safety,42(5), 232-239.
Link to PubMed citation: https://www.ncbi.nlm.nih.gov/pubmed/27066927
Link to full-text article: https://www.sciencedirect.com/science/article/pii/S1553725016420301?via%3Dihub
- Escobar, Gabriel J., Puopolo, Karen M., Wi, Soora, Turk, Benjamin J., Kuzniewicz, Michael W., Walsh, Eileen M., . . . Draper, David. (2014). Stratification of risk of early-onset sepsis in newborns more than or equal to 34 weeks’ g (Report). Pediatrics,133(1), 30.
Link to PubMed citation: https://www.ncbi.nlm.nih.gov/pubmed/24366992
Link to full-text article: http://pediatrics.aappublications.org/content/133/1/30.long
Link to supplement: http://pediatrics.aappublications.org/content/pediatrics/suppl/2013/12/18/peds.2013-1689.DCSupplemental/peds.2013-1689SupplementaryData.pdf
- Puopolo, K., Draper, D., Wi, S., Newman, T., Zupancic, J., Lieberman, E., . . . Escobar, G. (2011). Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics,128(5), E1155-63.
Link to PubMed citation: https://www.ncbi.nlm.nih.gov/pubmed/22025590
Link to full-text article: http://pediatrics.aappublications.org/content/128/5/e1155
Link to supplement: http://pediatrics.aappublications.org/content/pediatrics/suppl/2011/10/17/peds.2010-3464.DC1/zpe611117705p.pdf
GBS Prophylaxis – in order of most recent publication
Puopolo, Karen M., Lynfield, Ruth, & Cummings, James J. (2019). Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics,144(2), Pediatrics, August, 2019, Vol.144(2). https://doi.org/10.1542/peds.2019-1881
- Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion Summary, Number 782. (2019). Obstetrics & Gynecology,134(1), 206-210. https://www.acog.org/GBS
- GBS [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2019 [cited 2019Dec11]. Available from: https://www.cdc.gov/groupbstrep/guidelines/index.html
- Utah Department of Heath. December 2018. Increased Incidence of Early Onset Group B Streptococcus Infections in Utah
http://www.health.utah.gov/epi/diseases/streptococcal_infections_groupB/GBS_Recommendations.pdf
- Centers for Disease Control and Prevention. 2017. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group B Streptococcus, 2017. https://www.cdc.gov/abcs/reports-findings/survreports/gbs17.pdf
- Verani, J., Mcgee, L., & Schrag, S. (2010). Prevention of perinatal group B streptococcal disease–revised guidelines from CDC, 2010. Recommendations and Reports: Morbidity and Mortality Weekly Report. Recommendations and Reports,59(RR-10), 1-36. https://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf
Sepsis Definitions
1. Goldstein, B., Giroir, B., & Randolph, A. (2005). International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics*. Pediatric Critical Care Medicine, 6(1), 2-8.
2. Singer, M., Deutschman, C., Seymour, C., Shankar-Hari, M., Annane, D., Bauer, M., Angus, D. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 801-810.
Acknowledgments
Written and Hosted by: Paul Wirkus, MD, FAAP
Administrator/Producer/Photographer: Alisa Stoddard, UTAAP Executive Director
Audio Engineer: Phil Wirkus
Music by: Phil Wirkus
Guest: Con Yee Ling, MD, FAAP
Product-Specific Advertising/Link to Product Websites
No product-specific advertising of any type appears in this activity. No links to product websites appear in this activity.