Neonatal early-onset sepsis calculator curbs antibiotic use

Neonatal early-onset sepsis calculator curbs antibiotic use | Image Credit: Contemporary Pediatrics

Use of a neonatal early-onset sepsis (EOS) risk assessment tool leads to reduced use of antibiotics and lengths of stay in the neonatal unit, according to a study conducted in an Australian hospital. The tool, the Kaiser Permanente neonatal EOS calculator, is designed to guide decision making based on objective data available at birth. The physician inputs 5 risk factors: gestational age, highest maternal temperature, duration in hours of rupture of membranes, status of maternal Group B Streptococcus, and use of intrapartum antibiotics. In generating an estimate of the neonate’s EOS risk, along with suggestions for clinical management, the tool also takes into account the neonate’s clinical condition.

The retrospective study was conducted in a regional hospital during 2 6-month periods, the second of which followed the facility’s adoption of the calculator. Investigators relied on electronic and paper case records for data. In the first 6-month period, 951 neonates were born at 35 weeks’ or more of gestation and, in accordance with conventional EOS guidelines, 130 (13.7%) received intravenous (IV) antibiotics in the first 72 hours. Treatment was initiated in 113 neonates in the first 24 hours and in 14 on day 2 and in 3 on day 3. The most common reason for treatment was clinical condition (63.1% of cases) and the presence of maternal risk factors (31.5%). Mean length of stay for all babies was 4.4 days.

Antibiotic exposure and length of stay decreased during the second 6-month period. Of the 1,129 live births at 35 weeks’ gestation, 53 (4.7%) received IV antibiotics within the first 72 hours, with all therapy initiated within the first 24 hours. Clinical condition again was the primary indication for treatment (79.2%), followed by maternal risk factors (18.9%). Mean length of stay for all live births dropped to 2.13 days.

Mean length of stay specifically for neonates treated with antibiotics increased from the first to the second period, however. Investigators thought that this probably was because fewer clinically well neonates ended up in the Special Care Nursery to be treated with antibiotics after the EOS risk assessment tool was introduced.

THOUGHTS FROM DR. FARBER:

Anything that reduces the use of unnecessary medicine is fine with me. The calculator is available online for free. I also note that the study found NO cases of culture-proven sepsis, so we still have a ways to go at reducing antibiotic use.

Reference:

Gannon J, Strunk T, Friesen N, Saw C. Neonatal early-onset sepsis calculator: Impact on antibiotic use in a level II neonatal unit in Western Australia. Pediatr Neonatal. 2024; 65(1):71-75.Doi:10.10.1016/j.pedneo.2023.04.010.