Antibiotic Stewardship - APSA Practice Gaps 2019

For a well-appearing neonate with intact omphalocele and no maternal risk factors, the most appropriate antibiotic management is preoperative antibiotic given one hour before incision and discontinued within 72 hours.

Neonates with intact omphalocele do not need antibiotics just because they are in the NICU.

Neonates with ruptured omphalocele or gastroschisis (open abdomen) should receive antibiotics.

Neonates with duodenal atresia probably do not need antibiotics if they are going to the operating room within 24 to 48 hours.

For paint-and-wait management of omphalocele, no antibiotics are given as long as the mother did not have chorioamnionitis and the baby does not have a fever.

Neonatology colleagues may start empiric antibiotic therapy based on elevated inflammatory markers like CRP or procalcitonin in postoperative neonates.

Inflammatory markers go up after taking a baby to the operating room.

A randomized trial may be needed to determine whether inflammatory markers should guide antibiotic use in postoperative neonates.

Antibiotic stewardship is a hot topic and was considered important enough by the PDC to bring to the forum.

Some institutions have pediatrician advocates for antibiotic stewardship with programs and committees.

At some institutions, pediatric colleagues accuse surgeons of giving too many antibiotics for patients with tracheoesophageal fistulas and gastroschisis.

Multidisciplinary conferences and pathways for conditions like abdominal wall defects help keep all teams aligned on antibiotic stewardship.

Engaging pediatricians in the NICU and PICU to develop protocols and pathways helps streamline antibiotic use and ensure adherence.