Implementation of the Early-Onset Sepsis Risk Calculator at a Community Level I Nursery

Abstract

The objective of this retrospective cohort study was to decrease the frequency of laboratory draws and the number of neonates receiving empiric antibiotics who are born to mothers with chorioamnionitis from 100% to 50% 6 months following implementation of the sepsis risk calculator (SRC) at a level 1 community nursery. Data were compared pre- and post-implementation of the SRC using the Fischer’s exact test. The rate of intravenous (IV) antibiotic use decreased from 93% to 7% (P < .0001). The rate of blood culture collection decreased from 100% to 46% (P < .0001). With implementation of the SRC, administration of IV antibiotics, laboratory draws, and IV placement significantly decreased without increasing rates of early-onset sepsis in our patient population. Our study demonstrated that the SRC can be effectively and safely implemented at a level 1 community–based newborn nursery, resulting in a decrease in unnecessary medical treatment without negative patient outcomes.

Keywords

early onset sepsis neonates community nursery risk calculator

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References

Johnson

Messier

Early onset sepsis. S D Med. 2016;69:29-33.

Polin

; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129:1006-1015. doi:10.1542/peds.2012-0541

Apuzzio

Williams

SF.

Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol. 2016;128:205-206. doi:10.1097/AOG.0000000000001497

Escobar

Puopolo

, et al. Stratification of risk of early-onset sepsis in newborns ≥34 weeks’ gestation. Pediatrics. 2014;133:30-36. doi:10.1542/peds.2013-1689

Mukhopadhyay

Taylor

Von Kohorn

, et al. Variation in sepsis evaluation across a national network of nurseries. Pediatrics. 2017;139:e20162845. doi:10.1542/peds.2016-2845

Puopolo

Draper

, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128:e1155-e1163. doi:10.1542/peds.2010-3464

Leonardi

Binder

Griswold

Yalcinkaya

Walsh

. Utilization of a Neonatal Early-Onset Sepsis Calculator to Guide Initial Newborn Management. Pediatr Qual Saf. 2019;4(5):e214. doi:10.1097/pq9.0000000000000214

Kaiser Permanente. Neonatal early-onset sepsis calculator. Accessed May 7, 2020. https://neonatalsepsiscalculator.kaiserpermanente.org/

Manzoni

Dall’Agnola

Reducing unnecessary antibiotic exposure in preterm neonates: an achievable goal. Lancet Infect Dis. 2016;16:1094-1096. doi:10.1016/S1473-3099(16)30222-5

10.

Cotten

CM.

Adverse consequences of neonatal antibiotic exposure. Curr Opin Pediatr. 2016;28:141-149. doi:10.1097/MOP.0000000000000338

11.

Money

Newman

Demissie

Roth

Blau

Anti-microbial stewardship: antibiotic use in well-appearing term neonates born to mothers with chorioamnionitis. J Perinatol. 2017;37:1304-1309. doi:10.1038/jp.2017.137

12.

Jan

Ramanathan

Cayabyab

RG.

Chorioamnionitis and management of asymptomatic infants ≥35 weeks without empiric antibiotics. Pediatrics. 2017;140:e20162744. doi:10.1542/peds.2016-2744

13.

Newman

Puopolo

Draper

Escobar

GJ.

Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics. 2010;126:903-909. doi:10.1542/peds.2010-0935

14.

Hornik

Benjamin

Becker

, et al. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect Dis J. 2012;31:799-802. doi:10.1097/INF.0b013e318256905c

15.

Newman

Draper

Puopolo

Escobar

GJ.

Combining immature and total neutrophil counts to predict early onset sepsis in term and late preterm newborns: use of the I/T2. Pediatr Infect Dis J. 2014;33:798-802. doi:10.1097/INF.0000000000000297