Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines

Abstract

Background According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing antibiotic overtreatment and NICU admission among neonates ≥34 weeks’ gestational age (GA); however, some missed cases of culture-positive EOS have also been described. Methods Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks’ GA with birth weight ≤ 1500 g, 34–36 weeks’ GA neonates with suspected intraamniotic infection and neonates ≥34 weeks’ GA with three clinical signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks’ GA with risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they were divided into 3 study groups: 34–36 weeks’ GA newborns (n = 95, group A), ≥ 37 weeks’ GA newborns (n = 170, group B), and ≥ 34 weeks’ GA newborns (n = 265, group A + B). For each group, we compared the number of patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to evaluate the sample sizes. Results 32/265 (12.1%) neonates ≥34 weeks’ GA received antibiotics within the first 12 h of life. According to EOS calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001). Conclusion Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator. No negative consequences for patients were observed.

The impact of early empirical antibiotics treatment on clinical outcome of very preterm infants: a nationwide multicentre study in China

“…Puopolo and Mukhopadhyay conducted a study of 15,433 infants born at 22 to 28 weeks’ gestation in Neonatal Research Network centers from 2006 to 2014, those born by cesarean delivery with membrane rupture at delivery and absence of clinical chorioamnionitis were significantly less likely to have confirmed EOS [ 2 ]. Additionally, the neonatal EOS calculator is a clinical risk stratification tool increasingly used to guide the use of empirical antibiotics for newborns [ 28 ].…”

“…chorioamnionitis were significantly less likely to have confirmed EOS [2]. Additionally, the neonatal EOS calculator is a clinical risk stratification tool increasingly used to guide the use of empirical antibiotics for newborns [28]. In recent years, numerous studies have demonstrated that unnecessary or long-term use of antibiotics can increase the risk of adverse clinical outcomes in premature infants, and prolonged use of broad-spectrum antibiotics can cause strong selective pressure on microorganisms, which will in turn induce drug-resistance [29].…”

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

“…Limiting the clinical examination only to newborns with EOS risk factors can lead to missed diagnoses in newborns with no perinatal warnings [ 38 , 39 , 40 ]. We report the case of one patient of the P2 population, with no pre- or perinatal risk factors, who developed a severe form of GBS sepsis that led to his death.…”

Sustaining the Continued Effectiveness of an Antimicrobial Stewardship Program in Preterm Infants

“…Strategies to prevent neonatal sepsis, its early diagnosis, and timely treatment are essential to reduce its incidence, mortality, and sepsis-related complications [ 3 , 4 ]. However, clinical presentation may be nonspecific, reliable early markers of sepsis are currently unavailable, and risk factors have insufficient predictive value [ 5 , 6 ]. In preterm very-low-birth-weight (VLBW) infants, both the incidence of sepsis and the associated risks of mortality or complications are higher than in full-term infants [ 1 , 2 ].…”