Inter-specialty differences in the management of febrile neonates on prostaglandin E1

Objective: To assess inter-specialty differences in the management of febrile neonates receiving prostaglandin E1 (PGE1) for duct-dependent congenital heart disease. Study design: A cross-sectional, web-based survey was distributed to 800 neonatologists and pediatric cardiac intensivists in North America, Europe, and the Middle East. Respondents (n = 526) were queried regarding their management of a clinical vignette involving a febrile neonate on PGE1, including decisions about sepsis work-up, antibiotic administration, and lumbar puncture. Data were analyzed using chi-square tests and multivariate logistic regression. Result: Pediatric cardiac intensivists were significantly more likely to initiate full sepsis work-up and antibiotic therapy (65.6% vs. 38.7%, p < 0.001). Specialty was the only significant predictor of antibiotic administration (OR = 3.07, 95% CI: 1.76–4.40, p < 0.001). No significant differences were found in lumbar puncture practices. Conclusion: Significant inter-specialty variation exists in the management of febrile neonates on PGE1, highlighting the need for evidence-based guidelines to standardize care and optimize antimicrobial stewardship.