The management of infants ≥ 35 weeks’ gestation at risk for early-onset sepsis: an Italian survey

Abstract Background Despite the morbidity and mortality associated with early-onset sepsis, there are currently no national recommendations in Italy for its prevention or for the management of at-risk neonates. Moreover, no recent data are available on the strategies currently adopted in clinical practice. To address this gap, together with the Study Group on Neonatal Infectious Diseases of the Italian Society of Neonatology, we conducted a national cross-sectional survey investigating Group B Streptococcus (GBS) prevention strategies as well as management practices for infants ≥ 35 weeks’ gestation at risk for early-onset sepsis in Italy. Methods A structured, web-based questionnaire was developed, pilot tested and distributed to Italian birth centres in 2024–2025. Questions focused on birth centre activity, GBS prevention strategies (universal screening, intrapartum antibiotic prophylaxis), and management practices for asymptomatic infants ≥ 35 weeks’ gestation with distinct risks for GBS and non-GBS EOS (Scenario 1: GBS-positive mother with inadequate prophylaxis; Scenario 2: GBS-negative mother with prolonged rupture of membranes; Scenario 3: maternal fever/suspected chorioamnionitis). Results The response rate was 65% (229 out of 354 centres). In management of well-appearing at risk infants routine laboratory testing is reported by 42% of centres in Scenario 1, 27% in Scenario 2 and 65% in Scenario 3. Among centres performing laboratory workups, blood cultures are performed in approximately half of cases (36% to 59%, depending on the risk scenario), and empirical antibiotics are initiated in most cases when inflammatory biomarkers are elevated. Conclusions The 2024–2025 survey shows considerable heterogeneity and deviations from recommendations, particularly in the use of laboratory tests. The development of national Italian recommendations and targeted antimicrobial stewardship programs hold great potential to standardize care and reduce unnecessary antibiotic exposure.