Supplemental Material for: International Variations in the Use of Antimicrobials and Management of Sepsis: A Survey of 382 Neonatal Units in 12 Countries

This cross-sectional study surveyed neonatal intensive care units (NICUs) across 12 networks within the International Network for Evaluating Outcomes of Neonates. A pre-piloted online questionnaire captured unit-level practices regarding treatment duration for culture-proven infections, antifungal prophylaxis, blood culture collection, and central line management. Responses were analyzed descriptively at the network and unit levels.</p><p dir="ltr">Results: Of 608 eligible NICUs, 382 (62.8%) responded.

A 7-day treatment duration was most commonly reported for gram-positive sepsis (45.2% of NICUs), whereas 14 days was most commonly reported for gram-negative sepsis (44.4%). Treatment durations were longer for concurrent meningitis: 57% of units reported 14 days for gram-positive meningitis and 69.2% reported 21 days for gram-negative meningitis. Antifungal prophylaxis was reported by 62.1% of units.

Most NICUs (79.7%) routinely obtained blood cultures from a single sterile site. Overall, 75.7% of units reported central line removal for gram-negative sepsis and 57.3% for gram-positive sepsis. </p><p dir="ltr">Conclusion: Reported antimicrobial duration and sepsis management practices for very preterm infants varied across neonatal units and international networks. These findings underscore persistent uncertainty and the urgent need for high-quality evidence to inform standardized, evidence-based antimicrobial stewardship in this vulnerable population.</p>