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

Publication Number: 32.3894

Emily Murray, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Maria Mattioli, Nemours Children's Hospital, Philadelphia, PA, United States; Devon Rauscher, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Dorothy L. McElwee, TJUH, mullica hill, NJ, United States; Elizabeth Przychowicz, Thomas Jefferson University Hospital, Pennsauken, NJ, United States; Moira F.. Winstanley, Thomas Jefferson University Hospital, Philadelphia, PA, United States; David Carola, Nemours Children's Hospital, Philadelphia, PA, United States; Zubair H. 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 high contamination rate when collecting UCBC. A most recent study on UCBC from 195 preterm infants reported contamination rate of 9.2% (Bensouda B, Ped Research 2024).

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 September 2024. 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 our institution. An UCBC was collected in the delivery room. Upon admission to the Level III Neonatal Intensive Care Unit (NICU), an NBC was collected. Infants with clinical illness were started on empiric antibiotics. Asymptomatic infants were closely monitored. All cultures were monitored in the laboratory for five days. This study did not change or delay medical management.

Results: A total of 282 neonates had UCBC and 210 neonates had concomitant NBC sent during the study period. 268 (95.0%) were born to mothers with triple I. 95 (33.7%) infants were symptomatic at birth and 72 (25.5%) were treated with empiric antibiotics for persistent symptoms. Three UCBC (1.1%) were positive, two possible contamination (0.07%). Two NBC were positive (0.07%) with one contamination (0.035%). One infant had both cultures positive with E coli, infant was symptomatic and treated with antibiotics for 14 days. None of the neonates were treated with prolonged antibiotics for culture negative sepsis.

Conclusion(s): In this prospective cohort of infants with high risk of EONS, contamination rate of UCBC was extremely low. Our protocol and collection technique can be used by others to reduce contamination rate. 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.

Table 1: Demographics and clinical characteristics of the study subjects (n=282).
table1.pdf

Table 2: Infants with positive UCBC and NBC
table2.pdf