Managing Neonatal Severe Sepsis in Germany: A Preliminary Survey of Current Practices

Abstract

Background: In 2002 and 2007, the American College of Critical Care Medicine (ACCCM) provided clinical guidelines for hemodynamic support of pediatric and neonatal patients in septic shock. In 2008 and 2013, the Surviving Sepsis Campaign (SSC) Guidelines Committee offered up-to-date clinical guidelines for the management of severe sepsis and septic shock in adults and in pediatric patients. The aim of this study was to assess the standard of care of neonates with severe sepsis and septic shock in German neonatal intensive care units (NICUs) with regard to variability in management and guideline conformity.

Methods: 199 pediatric clinics in Germany were asked to describe their management of septic neonates in a telephone survey. The questionnaire that was used for the preliminary survey was designed based on the ACCCM and SSC clinical guidelines.

Results: A total of 90 (45%) surveys were completed and analyzed. Among all hospitals, the guidelines most commonly included in current practice patterns were obtaining cultures before administering antibiotics (100%), determining capillary refill time (99%), and using crystalloids for initial fluid therapy (97%). The guidelines least commonly included in current practice were determination of ammoniac to rule out inborn errors of metabolism (51%) and the use of dopamine as the first choice of hemodynamic support (48%).

Conclusions: The management of sepsis, severe sepsis, and septic shock in neonates is not always guideline consistent, but quite a number of ACCCM and SSC guidelines were included in the current practice pattern.

Zusammenfassung

Hintergrund: Das American College of Critical Care Medicine (ACCCM) veröffentlichte 2002 und 2007 Leitlinien zur Kreislaufunterstützung von pädiatrischen und neonatalen Patienten im septischen Schock. Weiterhin stellte 2008 und 2013 die Surviving Sepsis Campaign (SSC) Leitlinien zur Behandlung der schweren Sepsis und des septischen Schocks in pädiatrischen Patienten zu Verfügung. Das Ziel dieser Studie war, einen ersten Eindruck über den Betreuungsstandard der schweren neonatalen Sepsis in deutschen Kinderkliniken hinsichtlich der Variabilität im Management und der Richtlinien-Konformität zu erhalten.

Methode: 199 pädiatrische Kliniken in Deutschland wurden gebeten, ihr Management von septischem Neugeborenen in einer anonymen Telefonbefragung zu beschreiben. Der standardisierte Fragebogen wurde basierend auf den ACCCM und SSC Leitlinien entworfen.

Ergebnisse: Insgesamt 90 (45%) Fragebögen wurden vollständig beantwortet und analysiert. Die am häufigsten umgesetzten Leitlinienempfehlungen waren die Gewinnung von Blutkulturen vor Antibiotikabeginn (100%), Prüfung der kapillären Reperfusionszeit (99%) und der Einsatz von Kristalloiden zur initialen Volumentherapie (97%). Die in die gegenwärtige Praxis am wenigsten umgesetzten Leitlinienempfehlungen waren Ammoniakbestimmung zum differenzialdiagnostischen Ausschluss von metabolischen Erkrankungen (51%) und der Einsatz von Dopamin zur initialen Kreislaufunterstützung (48%).

Schlussfolgerung: Die Behandlung der neonatalen Sepsis ist nicht immer leitlinienkonform, doch viele der Empfehlungen der ACCM und SSC Leitlinien sind in die gegenwärtige klinische Routine integriert.

Key words

sepsis - newborn - survey - guidelines

Schlüsselwörter

Sepsis - Neugeboren - Umfrage - Leitlinien

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