208 - Are Umbilical Cord Blood Cultures Useful in the Diagnosis and Management of Infants at Risk for Early Onset Sepsis?

Poster Number: 208
Publication Number: 208.44

Emily J. Murray, Thomas Jefferson University Hospital, Philadelphia, PA, United States; Maria Mattioli, Nemours Health System/ Jefferson, Philadelphia, PA, United States; Devon M. Rauscher, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Dorothy L. McElwee, The Nemours Foundation, mullica hill, NJ, United States; Elizabeth Przychowicz, Thomas Jefferson University Hospital, Pennsauken, NJ, United States; Alexandra R. Webb, Nemours Children's Hospital, Philadelphia, PA, United States; Moira F.. Winstanley, Nemours Children's Health, Lansdale, PA, United States; David Carola, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Zubair Aghai, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States

Background: Blood cultures drawn from neonates (neonatal blood culture, NBC) are the gold standard for the diagnosis of early onset neonatal sepsis (EONS). Previously conducted studies show the use of umbilical cord blood cultures (UCBC) to be a painless and convenient way to culture neonates at high risk for EONS. Although, there have been concerns related to contamination when collecting UCBC.

Objective: The goal of this study is to evaluate the use of UCBC compared to NBC for the diagnosis and management of EONS. 

Design/Methods: As part of an IRB approved QI project to reduce empiric antibiotic use, UCBCs and NBCs were collected from infants at risk for EONS between December 2020 and December 2022. A core team was trained to sterilely collect UCBC in the delivery room. This team consisted of neonatal nurse practitioners and transport registered nurses who routinely attend high risk and premature deliveries at Thomas Jefferson University Hospital. An UCBC was collected in the delivery room. Upon admission to the Level III Intensive Care Nursery (ICN), an NBC was collected. Infants with clinical illness were started on empiric antibiotics. Asymptomatic infants were closely monitored in the ICN for a minimum of twelve hours. All cultures were monitored in the laboratory for five days. This study did not change or delay medical management.

Results: A total of 137 neonates had an UCBC and NBC sent during the study period. 125 (91.2%) were born to mothers with triple I. 60 (43.8%) infants were symptomatic at birth and 44 (32.1%) of them were treated with empiric antibiotics for persistent symptoms. Only one UCBC (0.73%) was positive (Streptococcus mitis) and one (0.73%) NBC was positive (Escherichia coli). There were no infants where both cultures were positive. The two neonates with positive blood cultures were empirically treated at the time of admission before reporting of bacterial growth. The positive UCBC was presumed to be a contaminant and antibiotics were stopped after 72 hours. The infant with a positive NBC was treated with appropriate antibiotics for 10 days. None of the neonates were treated with prolonged antibiotics for culture negative sepsis.

Conclusion(s): In this small prospective cohort of infants with high risk of EONS, contamination rate of UCBC was very low. NBC can be positive despite negative UCBC. UCBC can be used as a second BC in neonates with risk of EONS to reduce prolonged antibiotic use for culture negative sepsis.  If UCBC is used as an alternative to NBC, additional NBC is suggested in symptomatic neonates before starting empiric antibiotics.