Implementation of the Sepsis Risk Calculator at an Academic Birth Hospital

Dhudasia, Miren B.; Mukhopadhyay, Sagori; Puopolo, Karen M.

doi:10.1542/hpeds.2017-0180

Cited by 90 publications

(88 citation statements)

References 24 publications

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“…[1][2][3] After our QI practice changes, reductions in laboratory testing and antibiotic exposure were evident when looking across the entire cohort of late preterm and term infants (Fig 2). Our reductions in laboratory testing and antibiotic exposure are similar to those reported after implementation of serial examinations 15 or use of the NSC 13,14 at other centers. Collectively, these experiences indicate that substantial reductions in interventions for infants traditionally deemed at high risk for EOS can be achieved without adverse events.…”

Section: Discussionsupporting

confidence: 82%

“…Six patients were ill at birth; the other 4 had NSC risk estimates at birth ,0.3 per 1000 and developed signs of illness between 5 and 20 hours of age. 13 Dhudasia et al 14 reported 4 cases of culture-positive EOS in a cohort of 11 782 births; of these, 1 patient was ill at birth, 1 had a low NSC risk estimate (0.3 per 1000) at birth but developed signs of infection at 36 hours of age, and 2 were treated with antibiotics empirically because of elevated EOS risk estimates at birth (11.45 and 3.41 per 1000, respectively) and never developed signs of illness. These reports reveal the central role of serial clinical evaluations in identifying infected infants even when using the NSC.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] In 2 recent reports, researchers used the Neonatal Sepsis Calculator (NSC), which is an EOS prediction model based on clinical examination and 5 perinatal risk factors (highest maternal temperature, GBS status, duration of rupture of membranes, and the nature and timing of IAP), to guide the need for antibiotics demonstrated .40% reductions in empirical antibiotic use. 13,14 Two groups from Italy used serial clinical examinations alone to identify EOS in at-risk infants and demonstrated significant reductions in antibiotic use. 15,16 Neither approach was associated with adverse events.…”

mentioning

confidence: 99%

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Management of Chorioamnionitis-Exposed Infants in the Newborn Nursery Using a Clinical Examination–Based Approach

Joshi

Gupta

Allan

et al. 2019

Hospital Pediatrics

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BACKGROUND: Antibiotic use in well-appearing late preterm and term chorioamnionitis-exposed (CE) infants was reduced by 88% after the adoption of a care approach that was focused on clinical monitoring in the intensive care nursery to determine the need for antibiotics. However, this approach continued to separate mothers and infants. We aimed to reduce maternal-infant separation while continuing to use a clinical examination-based approach to identify early-onset sepsis (EOS) in CE infants. METHODS: Within a quality improvement framework, well-appearing CE infants $35 weeks' gestation were monitored clinically while in couplet care in the postpartum unit without laboratory testing or empirical antibiotics. Clinical monitoring included physician examination at birth and nurse examinations every 30 minutes for 2 hours and then every 4 hours until 24 hours of life. Infants who developed clinical signs of illness were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, and clinical outcomes were collected. RESULTS: Among 319 initially well-appearing CE infants, 15 (4.7%) received antibiotics, 23 (7.2%) underwent laboratory testing, and 295 (92.5%) remained with their mothers in couplet care throughout the birth hospitalization. One infant had group B Streptococcus EOS identified and treated at 24 hours of age based on new-onset tachypnea and had an uncomplicated course. CONCLUSIONS: Management of well-appearing CE infants by using a clinical examination-based approach during couplet care in the postpartum unit maintained low rates of laboratory testing and antibiotic use and markedly reduced mother-infant separation without adverse events. A framework for repeated clinical assessments is an essential component of identifying infants with EOS.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Management of Chorioamnionitis-Exposed Infants in the Newborn Nursery Using a Clinical Examination–Based Approach

Joshi

Gupta

Allan

et al. 2019

Hospital Pediatrics

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“…This hypothesis is further supported by a recent theoretical costbenefit analysis, which estimated a net monetary benefit of $3998 per infant with a 60% likelihood of net benefit in a US setting [7]. To our knowledge, despite signs of significant uptake [8] and multiple reports on adoption of the EOS calculator [3,9,10], no real-world evidence of the effect of EOS calculator use on financial costs associated with healthcare for suspected EOS has been published.…”

Section: Introductionmentioning

confidence: 69%

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

et al. 2020

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The neonatal early onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction of empiric antibiotic treatment for suspected EOS. We studied if implementation of the EOS calculator results in less healthcare utilization and lower financial costs of suspected EOS. For this, we compared two single-year cohorts of hospitalizations within 3 days after birth in a Dutch nonacademic teaching hospital, before and after implementation of the EOS calculator. All admitted newborns born at or after 35 weeks of gestation were eligible for inclusion. We analyzed data from 881 newborns pre-implementation and 827 newborns post-implementation. We found significant reductions in EOS-related laboratory tests performed and antibiotic days, associated with implementation of the EOS calculator. Mean length of hospital stay was shorter, and EOS-related financial costs were lower after implementation among term, but not among preterm newborns.Conclusion: In addition to the well-known positive impact on antibiotic stewardship, implementation of the EOS calculator is also clearly associated with reductions in healthcare utilization related to suspected EOS in late preterm and term newborns and with a reduction in associated financial costs among those born term.What is Known: • The early-onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction in empiric antibiotic treatment for suspected EOS. What is New:• In newborns at risk for EOS, EOS calculator implementation is associated with a significant reduction in laboratory investigations related to suspected EOS and significantly shorter stay in those born term. • EOS calculator implementation in term newborns is associated with a mean reduction of €207 in costs for EOS-related care per admitted newborn.

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“…The classification of infants as clinically ill, equivocal, or well appearing requires ongoing clinical assessment over the first 12 hours after birth. 44,46,48 Workflow changes could be needed to accommodate changes in the frequency of vital signs and other clinical assessments for infants who are identified as being at moderate risk of EOS. Those at institutions opting for this approach may set different risk thresholds for specific actions other than those that are validated 44,48 but should also consider quantifying the effect of the chosen risk thresholds to affirm safety and efficacy.…”

Section: Multivariate Risk Assessmentmentioning

confidence: 99%

Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

et al. 2018

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Implementation of the Sepsis Risk Calculator at an Academic Birth Hospital

Abstract: The SRC was integrated into the workflow of a large, academic perinatal center, resulting in significant reductions in antibiotics and laboratory testing for EOS and demonstrating the potential for this approach to impact national practice.

Cited by 90 publications

References 24 publications

Management of Chorioamnionitis-Exposed Infants in the Newborn Nursery Using a Clinical Examination–Based Approach

Management of Chorioamnionitis-Exposed Infants in the Newborn Nursery Using a Clinical Examination–Based Approach

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

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