Use of a Modified Early-Onset Sepsis Risk Calculator for Neonates Exposed to Chorioamnionitis

The Holy Grail of Ascertainment of Early-Onset Neonatal Sepsis

“…The work of Sloane et al adds to an expanding body of reports of both retrospective and prospective application of the Kaiser calculator to cohorts of late-preterm and term neonates in a variety of settings. 16 As noted in their Discussion, the performance of the calculator in these early reports has not lived up to the hopes of its creators and many current users. There is tyranny in small numbers.…”

“…Inattention to this crucial requirement leads to incorrect risk estimates, as likely demonstrated in the work by Sloane et al 16 In this instance, prior adjustment of the attack rate to match that observed among infants exposed to chorioamnionitis (4 per 1000 live births) followed by application of the odds ratios inherent in the calculator's regression model is tantamount to duplicate application of odds ratios for risk factors in the model that are covariant with chorioamnionitis (eg, maternal fever, prolonged rupture of membranes). The resulting very high estimates of risk across the subjects in this subgroup, therefore, are expected, virtually decreasing chorioamnionitis to a categorical criterion for intervention.…”

“…15 In this volume of The Journal, Sloane et al evaluate performance of the EOS calculator had it been used to estimate risk in infants whose mothers were diagnosed with chorioamnionitis in a single institution with good ascertainment of EOS cases over 11 years. 16 In doing so, their work exemplifies the complexities and potential pitfalls of generalization of logistic regression models that are derived from oversampled or undersampled cohorts of the underlying population. 17 In accordance with common practice in analyses of rare events, the original regression model used all 350 S.L.…”

“…The adoption of the Kaiser calculator-based algorithm may enable abandonment of out-of-date categorical risk ascertainment methods and will be an important step toward decreasing unnecessary diagnostic testing and treatments in many settings. Safe implementation must incorporate ongoing and careful observation of all infants, however, because more than one-third of the infants in the cohorts of Kuzniewicz et al 14 and Sloane et al 16 were only recognized because of postnatal development of clinical signs of illness. Current standards of care for women through the peripartum period in countries with highly developed healthcare systems have reduced mothers' mortality and morbidity dramatically October 2019 EDITORIALS from times when birthing had high risks.…”

Sensitivity of the Kaiser Permanente early-onset sepsis calculator: A systematic review and meta-analysis

“…There has been discussion in the literature about the use of the calculator amongst higher-risk groups of babies, specifically, babies exposed to chorioamnionitis [5,6]. We therefore performed a subgroup analysis of all papers focussed on chorioamnionitis exposed babies.…”