Background: Early-onset sepsis (EOS) is a potentially fatal condition that affects about 0.3–0.8/1,000 infants born at ≥35 weeks’ gestation in developed countries. Current EOS management algorithms result in 8–15% of infants receiving antibiotics for suspected sepsis. The Neonatal Sepsis Calculator provides evidence-based estimates of individual sepsis risk, but data on its clinical application is limited. Objectives: To evaluate the feasibility, safety, and effect on the newborn infants that were investigated and that received antibiotic treatment for suspected EOS following the introduction of the Neonatal Sepsis Calculator. Methods: This was a prospective, observational, single-centre cohort study comparing the rates of newborn infants born at ≥35 weeks’ gestation requiring evaluation and/or treatment for suspected EOS in a large tertiary perinatal centre before versus after the prospective introduction of the Neonatal Sepsis Calculator (Epoch 1: October 2014 to January 2015 vs. Epoch 2: July to December 2016). Results: There were 1,732 and 2,502 eligible infants born during Epochs 1 and 2, respectively. Of these, 425 (24.2%) and 530 (21.2%), respectively, were admitted to the neonatal unit. The proportion of infants investigated for sepsis decreased from 15.2 to 11.1%, and that of infants treated with antibiotics from 12.0 to 7.6%. One case of EOS occurred during each Epoch. Conclusions: The implementation of the Neonatal Sepsis Calculator was feasible and safe in our unit. Application of this clinical decision support tool may reduce the number of infants undergoing investigations and empirical treatment for suspected EOS.

Keywords:
Early-onset sepsis, Neonatal Sepsis Calculator, Clinical decision tool, Implementation
1.
Kuzniewicz MW, Puopolo KM, Fischer A, Walsh EM, Li S, Newman TB, Kipnis P, Escobar GJ: A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr 2017; 171: 365–371.
2.
Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, Hudson Jain J, Lynfield R: Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics 2016; 138.
3.
Mukhopadhyay S, Eichenwald EC, Puopolo KM: Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines. J Perinatol 2013; 33: 198–205.
4.
Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, Smith M, Escobar GJ: Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics 2011; 128:e1155–e1163.
5.
Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, Newman TB, Zupancic J, Lieberman E, Draper D: Stratification of risk of early-onset sepsis in newborns ≥34 weeks’ gestation. Pediatrics 2014; 133: 30–36.
6.
Brady MT, Polin RA: Prevention and management of infants with suspected or proven neonatal sepsis. Pediatrics 2013; 132: 166–168.
7.
Kuzniewicz MW, Walsh EM, Li S, Fischer A, Escobar GJ: Development and implementation of an early-onset sepsis calculator to guide antibiotic management in late preterm and term neonates. Jt Comm J Qual Patient Saf 2016; 42: 232–239.
8.
Stoll BJ, Hansen NI, Sanchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al; Eunice Kennedy Shriver National Institute of Child Health; Human Development Neonatal Research Network: Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics 2011; 127: 817–826.
9.
Saari A, Virta LJ, Sankilampi U, Dunkel L, Saxen H: Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life. Pediatrics 2015; 135: 617–626.
10.
Turta O, Rautava S: Antibiotics, obesity and the link to microbes – what are we doing to our children? BMC Med 2016; 14: 57.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.