BackgroundOver the past 2–3 years at the Southwest Peninsula tertiary neonatal unit in Plymouth, the authors have observed an increase in the number of clinically well term infants being screened and treated with antibiotics for infection in accordance with NICE guidance. The aim of our study was to assess the safety of implementing the Kaiser Permanente Early Onset Sepsis (KPEOS) calculator to minimise antibiotic usage in term infants in line with antimicrobial stewardship, reducing separation from mother at birth and facilitating earlier discharge.MethodsA 2-year retrospective review of medical records from 2014 to 2015 inclusive revealed 9217 deliveries, with 1550 infants (16.8%) having risk factors, 945 (10.2%) being term infants. Of those, 507 (53.6%) had a clinical reason to screen and 438 (46.4%) had risk factors alone treated with antibiotics for variable periods of time. This enabled us to review our usual practice and compare it with our KPEOS implementation.InterventionNational Health Service England permission was obtained to implement the KPEOS for a 6-month period. We collected data on all 175 term infants with risk factors to compare with our previous practice when The National Institute for Health and Care Excellence and Royal College of Obstetrics and Gynaecology maternal guidance was being followed.ResultsThe percentage of infants screened with a suspected infection previously receiving 5 days of antibiotics reduced from 31% (136/438) to 5% (9/157, p<0.0001) using the KPEOS calculator. Clinically well infants with risk factors alone previously receiving 36 hours of antibiotics, reduced from 63% (275/438) to 3% (5/157, p<0.0001) of infants treated. There was no late-onset sepsis in this study cohort or any observed adverse outcomes.ConclusionThese results demonstrated a potentially safe and effective quality improvement (QI) in our hospital with fewer babies treated and a reduced length of stay for this cohort. Considering individual hospitals rates for term Group B Streptococcal sepsis, this QI may be a safe and economical alternative to current practices for screening well term infants.

A newborn infant is described who presented with septicemia and meningoencephalitis caused by Plesiomonas shigelloides, a Gram-negative rod belonging to the family Vibrionaceae. This appears to be the first documented case in a neonate in Canada. Despite prompt treatment with appropriate antibiotics, he developed endophthalmitis and lytic brain lesions.

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The incidence of Necrotising enterocolitis (NEC) varies widely but occurs in approximately 1 in 1000 live births and up to 10% of Extremely Low Birth Weight Infants. Mortality is high around 20-30% but highest in preterm infants and in those requiring surgery. There is an association with feeds and bacteria in the pathogenesis as well as bacterial toxins. Formula milk is associated with a higher incidence of NEC than those infants receiving human milk or a mixture of both. There is no benefit in delaying the introduction of enteral feeds with breast milk but the rate of increase remains an area for research and discussion. An adopted standardized regime does appear to be protective. Further improvements in the prevention, diagnosis and treatment of NEC are still required.

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