Use of Early-Onset Sepsis Risk Calculator for Neonates ≥ 34 Weeks in a Large Tertiary Neonatal Centre, Saudi Arabia

Huseynova, Roya; Mahmoud, Latifa Bin; Aljobair, Fahad; Huseynov, Ogtay; Career, Halima; Jaganathan, Parameaswari P.; Abdelrahim, Adli; Alaklobi, Faisal

doi:10.7759/cureus.14620

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…SRC implementation would also lead to fewer NICU admissions, decreased length of stay in the NICU, and fewer laboratory tests. 13 In our study, the SRC recommended antibiotic management in 15 patients (0.5%) and only 2 patients had positive blood cultures. The number of patients recommended for antibiotics by the SRC was low, thus minimizing the exposure to antibiotics without missing a case of sepsis.…”

Section: Discussionmentioning

confidence: 58%

“…Several studies evaluated the calculator's safety in different countries and populations, permitting it to be a tool for proper neonatal antibiotics stewardship. 11 These studies have included Germany, 6 the United Kingdom, 12 Saudi Arabia, 13 the Netherlands, and Australia. 11 As of yet, use of the SRC has not been studied or validated in the Lebanese population.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Efficacy and Safety of the Neonatal Sepsis Risk Calculator in a Tertiary Referral Center in Lebanon

Neaimeh,

Ard,

Daher

et al. 2024

J Pediatr Infect Dis

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Objective Early onset sepsis (EOS) is a significant cause of morbidity and mortality in the newborn period. This has led to overinvestigation and antibiotic overuse, which remains a concern in EOS management. Sepsis risk calculator (SRC), a tool validated in American and European populations, aids physicians in sepsis risk stratification and has been shown to decrease antibiotics overuse for EOS. The aim of the study was to evaluate the efficacy and safety of the SRC in a tertiary referral center in Lebanon. Methods This was a single-center retrospective cohort study, conducted at a tertiary medical center in Beirut, Lebanon, that included infants born at more than 34 weeks' gestational age between January 1, 2017 and January 1, 2019. Data was collected on risk factors for neonatal sepsis and the clinical management performed on each newborn. The SRC was used to calculate a sepsis risk score for each patient. Comparison between actual management performed and SRC recommendation was measured. Results We reviewed 3,085 charts, out of which 257 charts were excluded. Patients were stratified into two groups: high sepsis risk and low sepsis risk. Out of the 2,828 patients included, 81 infants (2.9%) had high risk of sepsis, out of which 2 patients had positive blood cultures. There were no patients with a low SRC score who had positive blood cultures. There were no patients who were supposed to receive antibiotics per the SRC recommendation who did not undergo workup for sepsis. Implementing SRC would have prevented antibiotics administration in 42 (1.5%) patients. Conclusion SRC was adequately capable of detecting neonates with sepsis without missing actual cases of EOS, providing initial support for its safety in the population studied. Implementing the SRC would result in reduced usage of antibiotics, laboratory tests, and admissions to the neonatal intensive care unit.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Evaluation of the Efficacy and Safety of the Neonatal Sepsis Risk Calculator in a Tertiary Referral Center in Lebanon

Neaimeh,

Ard,

Daher

et al. 2024

J Pediatr Infect Dis

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“…However, it is not expected to be superior in terms of antibiotic optimisation. 20 Sepsis risk calculators are infrequently employed in many regions of the world, and this is in part because they have not been validated in these contexts so clinicians are reluctant to make decisions using them. Here, we suggest a pragmatic use of such a calculator, focusing just on well-appearing infants as a way of introducing the concept to new clinicians and lowering the barriers to use the SRC.…”

Section: Introductionmentioning

confidence: 99%

Evaluating a Modified Use of the Kaiser Permanente Early-onset Sepsis Risk Calculator to Reduce Antibiotic Exposure: a Retrospective Study

Alhindi,

Almalki,

Al Saif

et al. 2024

bmjpo

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BackgroundEarly-onset neonatal sepsis (EONS) remains an important disease entity due to very serious adverse outcomes if left untreated. Lack of diagnostic tools in identifying healthy from diseased neonates, and clinicians’ fear of the missing positive-culture sepsis babies, or babies with clinical sepsis have led to overtreating and unnecessary antibiotic exposure. Kaiser Permanente EONS risk calculator is an internally validated tool that can predict EONS. This sepsis risk calculator (SRC) classifies neonates into three subgroups: (1) ill-appearing, (2) equivocal and (3) well-appearing. We propose a modification to this tool that aims to use it solely for well-appearing babies. This modification represents a more conservative approach to decrease antibiotic exposure and offers an alternative for those hesitant to fully implement this tool.MethodsThis is a dual-centre retrospective study where data were extracted from the electronic medical records. Our primary outcome was to validate the modified use of the SRC with a two-by-two table. Specificity, negative predictive value and expected antibiotic reduction were used to evaluate the tool’s feasibility.ResultAmong 770 babies suspected of EONS, the feasibility of the modified use was tested. The expected antibiotic exposure reduction rate on the modification was 40.4% overall. The proposed modification resulted in a specificity and negative predictive value of 99.28% (95% CI: 97.92% to 99.85%) and 99.5% (95% CI: 99% to 99.8%), respectively.ConclusionThe modified use of the sepsis risk calculator has shown that it can safely reduce antibiotic exposure in well-appearing babies. The modified use is used as a ‘rule out’ test that can identify very low risk of EONS babies, and safely minimise antibiotic exposure. Further prospective studies are needed to examine the efficacy of this use, and quality improvement projects are required to evaluate its applicability in different clinical settings.

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“…Furthermore, GBS screening for pregnant women is not a standard of care in Saudi Arabia yet ( 16 ). A recent cohort study identified the risk for early NS in Saudi Arabia to be 0.5/1,000 live births ( 17 ). A unified management plan of at-risk neonates can help further reduce the risk of complications posed by having an early neonatal infection ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

Quality assessment of clinical practice guidelines for neonatal sepsis using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument: A systematic review of neonatal guidelines

et al. 2022

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Background and objectiveNeonatal sepsis (NS) continues to be a critical healthcare priority for the coming decades worldwide. The aim of this study was to critically appraise the quality of recent clinical practice guidelines (CPGs) for neonatal sepsis and to summarize and compare their recommendations.MethodsThis study involves a systematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases and professional societies. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) instrument. We summarized the recommendations in a comparison practical table. The systematic review was drafted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Its protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42021258732).ResultsOur search retrieved 4,432 citations; of which five CPGs were eligible and appraised: American Academy of Pediatrics (AAP 2018) (35 and 34 weeks); Canadian Pediatric Society (CPS 2017); National Institute for Health and Care Excellence (NICE 2021); and Queensland Maternity and Neonatal Services (QH 2020). Among these, the overall assessment of two evidence-based CPGs scored > 70% (NICE and QH), which was consistent with their higher scores in the six domains of the AGREE II instrument. In domain 3 (rigor of development), NICE and QH scored 99 and 60%, respectively. In domain 5 (applicability), they scored 96 and 74%, respectively, and in domain 6 (editorial independence), they scored 90 and 71%, respectively.ConclusionThe methodological quality of the NICE CPG was superior followed by the QH CPG with relevant recommendations for use in practice.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021258732, PROSPERO (CRD42021258732).

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Use of Early-Onset Sepsis Risk Calculator for Neonates ≥ 34 Weeks in a Large Tertiary Neonatal Centre, Saudi Arabia

Cited by 4 publications

References 27 publications

Evaluation of the Efficacy and Safety of the Neonatal Sepsis Risk Calculator in a Tertiary Referral Center in Lebanon

Evaluation of the Efficacy and Safety of the Neonatal Sepsis Risk Calculator in a Tertiary Referral Center in Lebanon

Evaluating a Modified Use of the Kaiser Permanente Early-onset Sepsis Risk Calculator to Reduce Antibiotic Exposure: a Retrospective Study

Quality assessment of clinical practice guidelines for neonatal sepsis using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument: A systematic review of neonatal guidelines

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