About

Sarah A. Coggins, MD, MSCE, is an Assistant Professor of Pediatrics specializing in Neonatology and Newborn Services at the Children's Hospital of Philadelphia. She is also an Attending Neonatologist at both the Children's Hospital of Philadelphia and Pennsylvania Hospital. Her educational background includes a Bachelor of Arts in Molecular & Cellular Biology and Spanish from Vanderbilt University, an MD from Vanderbilt University School of Medicine, and a Master of Science in Clinical Epidemiology from the University of Pennsylvania School of Medicine. Her research focuses on neonatal infections, sepsis, and pharmacology, with numerous presentations and publications addressing epidemiology, antibiotic susceptibility, and neonatal care practices.

Research topics

• Medicine
• Pediatrics
• Intensive care medicine
• Internal medicine
• Emergency medicine

Selected publications

• Authors’ reply to: Todd et al., prenatal and intrapartum antibiotic exposure and childhood infections: considerations and complexities

  The Lancet Regional Health - Americas · 2026-01-09

  articleOpen access1st authorCorresponding

  We appreciate the interest from Todd and co-authors regarding our paper, entitled “Perinatal antibiotic exposure and risk of childhood infections: a retrospective cohort study”.1 We wish to respond to the following points:

  PublisherDOI

• Advances in Pediatric Therapeutic Drug Monitoring

  PEDIATRICS · 2025-12-18 · 1 citations

  articleOpen access1st authorCorresponding

  Therapeutic drug monitoring (TDM) is indicated for drugs with narrow therapeutic indices, whereby clinicians can adjust drug dosing to promote efficacy while limiting toxicity risk. Such monitoring is particularly important in managing infectious diseases, as both patient- and organism-specific factors must be considered to achieve optimal clinical responses. Innovation in pediatric TDM lags behind adults, largely due to a paucity of data and feasibility issues with lab draws and pharmacy resources. Emerging techniques in pharmacokinetic (PK) modeling, PK study design, flexible sampling strategies, and reduced sample volume requirements are particularly promising for TDM advancement in neonates and children. In this article, we discuss recent advancements in vancomycin TDM as a model case. Vancomycin is commonly used to treat serious gram-positive infections in children, and monitoring was historically performed using trough concentration-based guidance. Emerging data suggest that vancomycin troughs are not reliable surrogates for efficacy or toxicity and that trough-based monitoring is associated with increased risk of nephrotoxicity without clinical benefits. The area under the concentration-time curve (AUC) is the optimal pharmacokinetic-pharmacodynamic metric to measure overall vancomycin exposures, and consensus infectious diseases and pharmacist society guidance has formally recommended a shift toward AUC-based monitoring and away from trough-based monitoring in all age groups-including in neonates and children. We compare approaches to TDM in infectious diseases and summarize the body of literature describing application of vancomycin AUC-guided monitoring in children and neonates. Finally, we highlight opportunities and potential barriers to implementation of AUC-guided TDM in pediatric populations.

  PublisherOA PDFDOI

• Vancomycin Concentrations in Umbilical Cord Blood After Intrapartum Exposure

  Obstetrics and Gynecology · 2025-02-06 · 1 citations

  article1st authorCorresponding

  Little is known about the fetal-neonatal pharmacokinetics of maternally administered, weight-based vancomycin dosing for group B streptococcus (GBS) intrapartum antibiotic prophylaxis. Our objective was to quantify vancomycin concentrations in umbilical cord blood at birth after weight-based maternal intrapartum vancomycin administration and to assess cord blood vancomycin levels relative to the established GBS clinical minimum inhibitory concentration (MIC) breakpoint. Using a convenience sample of stored sera from our biorepository, we measured vancomycin levels in umbilical cord blood from 26 neonates after maternal intrapartum vancomycin exposure. Most neonates (24/26, 92.3%; 95% CI, 74.9-99.1%) had vancomycin cord blood levels above the MIC breakpoint (1 microgram/mL or higher) for GBS.

  PublisherDOI

• Late Antibiotic Use Among Preterm Infants Admitted to the Neonatal Intensive Care Unit

  PEDIATRICS · 2025-10-16

  articleOpen access1st authorCorresponding

  BACKGROUND AND OBJECTIVE: To describe antibiotic use patterns in preterm infants aged over 3 days. METHODS: This was a retrospective cross-sectional cohort study using the Premier Health Database, including infants at or under 34 weeks' gestation who were admitted to a neonatal intensive care unit (NICU) from 2009 to 2023. Infants who were transferred, discharged, or who died before day 4 and antibiotic courses initiated on days 1 through 3 after birth were excluded. Late antibiotic regimens were defined by initiation on or after day 4 and categorized by the antibiotics prescribed on the first day of each course. Outcomes included the proportion of infants exposed to any late antibiotic, distribution of antibiotic regimens over the study period, and distribution of antibiotic regimens over the course of NICU hospitalization. RESULTS: Among 420 687 eligible infants admitted to 699 centers over 15 years, 65 398 infants (15.5%) were administered late antibiotics. Antibiotic administration was inversely correlated with gestational age, with 75.0% of infants born 22 to 24 weeks given late antibiotics. There were 1020 unique late antibiotic regimens identified: vancomycin and gentamicin (19.2%) and ampicillin and gentamicin (12.0%) were the most frequent late regimens. Between 2009 and 2023, use of nafcillin or oxacillin-containing regimens (7.3% to 17.8%) and use of piperacillin/tazobactam or cefepime-containing regimens (4.5% to 24.3%) increased, whereas the use of vancomycin-containing regimens decreased (58.8% to 36.0%). Antibiotic choice changed over the NICU care course, with cefazolin being the dominant exposure after 90 days of age. CONCLUSIONS: Significant heterogeneity in late antibiotic administration and content supports the need for late antibiotic stewardship guidance among preterm infants.

  PublisherOA PDFDOI

• Vancomycin Concentrations in Umbilical Cord Blood After Intrapartum Exposure

  Obstetric Anesthesia Digest · 2025-08-20

  article1st authorCorresponding

  ( Obstet Gynecol . 2025;145:435–438 DOI: 10.1097/AOG.0000000000005843) A study investigated the presence of vancomycin (VANC) in umbilical cord blood following maternal intrapartum administration using current weight-based dosing guidelines for group B Streptococcus (GBS) prophylaxis. The objective was to assess whether these concentrations reached or surpassed the established minimum inhibitory concentration (MIC) needed to prevent neonatal GBS infection. Moreover, GBS colonization affects nearly 30% of pregnant individuals in the United States, and standard intrapartum antibiotic prophylaxis (IAP) involves beta-lactam antibiotics such as penicillin or ampicillin. However, for those with severe beta-lactam allergies and clindamycin-resistant GBS strains, weight-based VANC is recommended. Unlike beta-lactams, VANC transfers less efficiently through the placenta and is rapidly cleared during pregnancy due to increased kidney filtration. Concerns persist about whether VANC reaches effective fetal concentrations. Existing guidelines from the American Academy of Pediatrics suggest VANC is insufficient for GBS IAP, and data on fetal exposure using updated dosing remains limited.

  PublisherDOI

• Diagnostic evaluation to identify infection-attributable stillbirth

  Journal of Perinatology · 2025-03-06

  articleOpen access1st authorCorresponding

  OBJECTIVE: To characterize stillbirth evaluations, including the frequency and yield of investigations for infections causing stillbirth. STUDY DESIGN: Retrospective cohort of stillbirths at three university-affiliated perinatal centers from 2017 to 2022. The primary outcome was adherence to American College of Obstetrics and Gynecology core stillbirth evaluation recommendations (placental pathology, fetal autopsy, and fetal genetic testing). We further characterized the prevalence and yield of specific testing to evaluate for infection-attributable stillbirth etiologies. RESULTS: The cohort included 399 stillbirths. Placental pathology was performed in 387 cases (97.0%), fetal genetic testing in 163 (40.9%), and fetal autopsy in 126 (31.6%). Fetal bacterial cultures were obtained in 73 (18.2%) cases; potential pathogens were isolated in 21/73 (28.8%). Viral testing was sent infrequently, with variable yield. Six stillbirths had infections identified as probable etiologies. CONCLUSIONS: Adherence to core stillbirth evaluation recommendations was poor, and infection testing was infrequent. Infection-attributable stillbirth prevalence may be underestimated.

  PublisherOA PDFDOI

• Perinatal antibiotic exposure and risk of childhood infections: a retrospective cohort study

  The Lancet Regional Health - Americas · 2025-10-17

  articleOpen access1st authorCorresponding

  Background: Epidemiological studies report associations between antibiotics given during pregnancy, childbirth, and infancy and subsequent risk for childhood infections. The specific role of intrapartum and neonatal antibiotic exposures is not well-described. Methods: Retrospective cohort study of healthy term infants through 6 years of age. The primary exposure was perinatal antibiotics, defined as intravenous intrapartum antibiotic administration during the admission for childbirth or administered to the infant ≤3 days after birth. The primary outcome was infection-related inpatient encounters. Adjusted multivariable-adjusted Cox proportional hazards and marginal means/rates models were used to investigate the association between exposure and outcome. A secondary analysis examined the association between early infant antibiotics administered during the first three months after birth, including perinatal antibiotics, and the outcome. Findings: Of 13,919 infants, 3936 (28%) had perinatal antibiotic exposure. 1294 (9.3%) children had 1619 inpatient encounters, of which 988 (61%) were infection-related. Infection-related inpatient encounters occurred in 265 (6.7%) children exposed to perinatal antibiotics, compared to 584 (5.8%) unexposed children (risk difference 1.2%, 95% CI 0.3-2.1%, p = 0.005). In multivariable-adjusted models, perinatal antibiotic exposure was not associated with infection-related inpatient encounters [Cox model: aHR 1.16, 95% CI 0.95, 1.51, p = 0.15; marginal rates/means model: aHR 1.22, 95% CI 0.98, 1.51, p = 0.08]. Early infant antibiotics were also not associated with the outcome. Interpretation: In this study of 13,919 newborns across 24 primary pediatric practices, perinatal or early infant antibiotic exposure was not associated with subsequent early childhood hospitalization for infectious diseases. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, funding (K23 HD088753) supported this study.

  PublisherDOI

• A model for prevention: applying lessons from Group B Streptococcus to Staphylococcus aureus in very low birth weight neonates

  Journal of Perinatology · 2025-11-27

  article
  PublisherDOI

• Pharmacokinetic and Pharmacodynamic Approaches to Optimize Antibiotic Use in Neonates

  Clinics in Perinatology · 2024-12-21 · 4 citations

  review1st authorCorresponding
  PublisherDOI

• Umbilical cord blood gentamicin concentrations following maternally-administered intrapartum exposures

  Pediatric Research · 2024-10-30 · 1 citations

  letter1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Karen M. Puopolo

  Children's Hospital of Philadelphia

  29 shared

• Dustin D. Flannery

  Children's Hospital of Philadelphia

  24 shared

• Sagori Mukhopadhyay

  17 shared

• Jörn-Hendrik Weitkamp

  16 shared

• Jeffrey S. Gerber

  Children's Hospital of Philadelphia

  13 shared

• Mary Catherine Harris

  University of Pennsylvania

  11 shared

• Lakshmi Srinivasan

  University of Pennsylvania

  11 shared

• Amanda Gottschalk

  Philadelphia University

  9 shared

Education

• Residency, Pediatrics

  Children's Hospital of Philadelphia

• Clinical Fellow, Neonatology

  Children's Hospital of Philadelphia

• BA, Molecular & Cellular Biology, Spanish

  Vanderbilt University

• MD

  Vanderbilt University School of Medicine

• Master of Science in Clinical Epidemiology, Department of Biostatistics, Informatics, and Epidemiology

  University of Pennsylvania

  2023