Implementation of the Neonatal Sepsis Calculator in Early-Onset Sepsis and Maternal Chorioamnionitis

Abstract

Background: Utilization of the neonatal sepsis calculator published by Kaiser Permanente is rapidly increasing. This freely available online tool can be used in assessment of early-onset sepsis (EOS) in newborns 34 weeks' gestation or more based on maternal risk factors and neonatal examination. However, many hospitals lack standard guidelines for its use, leading to provider discomfort with practice change. Purpose: The goal of this project was to study the antibiotic use rate for EOS at a level III neonatal intensive care unit and create standardized guidelines and staff education for using the sepsis calculator. Our ultimate goal was to decrease antibiotic use for EOS in newborns 34 weeks' gestation or more. Methods: A standard quality improvement Plan-Do-Study-Act (PDSA) model was utilized with a plan to study the problem, implement the intervention, and test again for improvement. The primary outcome of interest was a decrease in the use of antibiotics for EOS in neonates 34 weeks' gestation or more. Results: Over a 4-month period, prior to sepsis calculator implementation, antibiotic use for suspected EOS was 11% and blood culture was done on 14.8% of live births. After implementation of the sepsis calculator and completion of the PDSA cycle, sepsis calculator use was greater than 95%, antibiotic use dropped significantly to 5% (P = .00069), and blood culture use dropped to 7.6% (P = .00046). Implications for Practice: Staff education and systematic intervention using a PDSA model can significantly impact patient care, decreasing the administration of antibiotics to infants at risk for sepsis. Implications for Research: Future research is needed to decrease antibiotic use in premature infants less than 34 weeks' gestation with similar risk factors and clinical features. Video Abstract available at https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=34&autoPlay=true

What’s new in the management of neonatal early-onset sepsis?

“…The risk of sepsis per 1000/live births is further quantified with consideration of the infant’s clinical condition after birth, classified as well appearing, equivocal or clinical illness 18 19. Multiple studies have confirmed that implementation of the sepsis calculator has significantly decreased lab sampling and antibiotic use in low-risk infants without adverse outcomes 20–23…”

Neonatal Early Onset Sepsis: Impact of Kaiser Calculator in an Italian Tertiary Perinatal Center

“…Arora et al 6 reported a significant reduction in sepsis evaluations (from 90.9% to 68.8%) and a reduction in antibiotic therapy by 29.4% in infants ≥34 weeks' gestation admitted to the NICU. Akangire et al 16 showed a decrease of blood cultures from 14.8% to 7.6%, and a reduction of empirical antibiotic administration from 11% to 5% in neonates at 34 weeks' gestation or more. Implementation of the EOS calculator decreased unnecessary painful procedures, while NICU admissions enabled healthyappearing infants to remain in the newborn nursery with their mothers, and as such promoted bonding.…”

Implementation of a Modified Neonatal Early-onset Sepsis Calculator in Well-baby Nursery: a Quality Improvement Study

“…Still, the postnatal categorization into clinical illness or equivocal group based on the clinical assessment could result in falsely elevated EOS risk as the definitions of equivocal or symptomatic are vague and nonspecific. For instance, Akangire et al 30 found that infants with small pneumothoraces and mild pulmonary hypertension were misclassified as symptomatic infants. Also, the threshold to intervene in symptomatic newborn infants may vary among practitioners.…”