Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement

Abstract

Objectives The Northern California Kaiser-Permanente Neonatal Sepsis Risk Calculator (SRC) has proved to be safe and effective in reducing laboratory tests, hospital admissions, and administration of antibiotics to patients at risk of early-onset neonatal sepsis (EONS). Many studies have focused on maternal chorioamnionitis as the principal risk factor for EONS. We wanted to know if the use of the SRC could be equally efficient in the context of several other infectious risk factors (IRF), in addition to chorioamnionitis, such as intrapartum maternal fever, GBS colonization and/or prolonged rupture of membranes (PROM). Methods Systematic study of neonates with ≥35 weeks gestational age (GA), born in our tertiary university hospital during a period of 18 months. Patients were retrospectively assessed with the SRC and its recommendations were compared with the actual management. A bivariate analysis of perinatal interventions, and outcomes was performed. Results A total of 5,885 newborns were born during the study period and 1783 mothers (31%) had at least one IRF. The incidence of culture-proven EONS was 0.5‰. The use of the SRC would have reduced laboratory evaluations (CBC and CRP) from 56.2 to 23.3%, and blood cultures, hospital admissions and antibiotic therapy from 22.9 to 15.5%, 17.8 and 7.6%, respectively. The management based on patients’ symptoms would have shown a reduction to 7.5% in all the outcomes of interest. Conclusions Both, the SRC and the management based on clinical findings, are safe and efficient to reduce the number of analytical studies, hospital admissions and administration of antibiotics to neonates with IRF.

Improved efficiency in the management of newborns with infectious risk factors by the sepsis risk calculator and clinical observation

“…The results of Period 1 have been published in detail previously. 15 For the present study a total of 1796 patients ≥35 weeks GA with at least one IRF (Period 1) are compared to 1867 newborns (Period 2) with similar characteristics.

Figure 1 Flowchart.

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“…During Period 1 (January 1, 2018 to June 30, 2019), before the introduction of the SRC, management criteria were based on local protocols, mostly derived from international recommendations. 15 During the second Period (July 1, 2019 to December 31, 2020), after the introduction of the SRC, an internal management protocol for newborns with IRF was developed based on the SRC. All patients with at least one IRF were evaluated using the protocol, although the final management decision rested with the attending neonatologist.…”

“… 14 In our center, a previous retrospective study seeking to optimize the use of antibiotics in newborns ≥35 weeks GA showed that the use of the SRC would have decreased significantly the number of infectious workups and hospital admissions of newborns with IRF, as well as the proportion of infants receiving antibiotics. 15 The objective of the present study was to prospectively evaluate the efficiency of the implementation of the SRC in our setting and to know if a management based on clinical observation would have been equally safe and efficient. The authors hypothesized that the implementation of the SRC would reduce laboratory draws, hospital admissions, and the administration of broad-spectrum antibiotics to neonates ≥35 weeks GA with IRF and that the management based on clinical observation would not be inferior.…”