933 Review of the NICE guidance for early onset neonatal sepsis with the use of a sepsis risk calculator

ObjectiveTo compare the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with National Institute for Health and Care Excellence (NICE) guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis (EOS).DesignRetrospective multicentre study.SettingFive maternity services in South West of England and Wales.Patients70 infants with EOS (<72 hours) confirmed on blood or cerebrospinal fluid culture.MethodsRetrospective virtual application of NICE and SRC through review of maternal and neonatal notes.Main outcome measureThe number of infants recommended antibiotics by 4 hours of birth.ResultsThe incidence of EOS ≥34 weeks was 0.5/1000 live births. Within 4 hours of birth, antibiotics were recommended for 39 infants (55.7%) with NICE, compared with 27 (38.6%) with SRC. The 12 infants advised early treatment by NICE but not SRC remained well, only one showing transient mild symptoms after 4 hours. Another four babies received antibiotics by 4 hours outside NICE and SRC guidance. The remaining 27 infants (38.6%) received antibiotics when symptomatic after 4 hours. Only one infant who was unwell from birth, died. Eighty-one per cent of all EOS infants were treated for clinical reasons rather than for risk factors alone.ConclusionWhile both tools were poor in identifying EOS within 4 hours, NICE was superior to SRC in identifying asymptomatic cases. Currently, four out of five EOS have symptoms at first identification, the majority of whom present within 24 hours of birth. Antibiotic stewardship programmes using SRC should include enhanced observation for infants currently treated within NICE guidance.

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G560(P) Safety of the kaiser permanente early onset neonatal sepsis risk calculator: a multi centre retrospective study

10.1136/archdischild-2020-rcpch.478 ◽

2020 ◽

Author(s):

KJ Pettinger ◽

C Breidenbach-Roe ◽

KJ Mayers ◽

T Pettinger ◽

B Phillips ◽

...

Keyword(s):

Retrospective Study ◽

Neonatal Sepsis ◽

Early Onset ◽

Risk Calculator ◽

Kaiser Permanente ◽

Sepsis Risk

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Implementation of an adapted Sepsis Risk Calculator algorithm to reduce antibiotic usage in the management of early onset neonatal sepsis: a multicentre initiative in Wales, UK

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-321489 ◽

2021 ◽

pp. fetalneonatal-2020-321489

Author(s):

Nitin Goel ◽

Stephanie Cannell ◽

Gemma Davies ◽

Murali Sridhar Natti ◽

Vickness Kirupaalar ◽

...

Keyword(s):

Outcome Measures ◽

Neonatal Sepsis ◽

Early Onset ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Consensus Guideline ◽

Risk Calculator ◽

Live Births ◽

Sepsis Risk ◽

The Impact

ObjectiveAssess the impact of introducing a consensus guideline incorporating an adapted Sepsis Risk Calculator (SRC) algorithm, in the management of early onset neonatal sepsis (EONS), on antibiotic usage and patient safety.DesignMulticentre prospective studySettingTen perinatal hospitals in Wales, UK.PatientsAll live births ≥34 weeks’ gestation over a 12-month period (April 2019–March 2020) compared with infants in the preceding 15-month period (January 2018–March 2019) as a baseline.MethodsThe consensus guideline was introduced in clinical practice on 1 April 2019. It incorporated a modified SRC algorithm, enhanced in-hospital surveillance, ongoing quality assurance, standardised staff training and parent education. The main outcome measure was antibiotic usage/1000 live births, balancing this with analysis of harm from delayed diagnosis and treatment, disease severity and readmissions from true sepsis. Outcome measures were analysed using statistical process control charts.Main outcome measuresProportion of antibiotic use in infants ≥34 weeks’ gestation.Results4304 (14.3%) of the 30 105 live-born infants received antibiotics in the baseline period compared with 1917 (7.7%) of 24 749 infants in the intervention period (45.5% mean reduction). All 19 infants with culture-positive sepsis in the postimplementation phase were identified and treated appropriately. There were no increases in sepsis-related neonatal unit admissions, disease morbidity and late readmissions.ConclusionsThis multicentre study provides evidence that a judicious adaptation of the SRC incorporating enhanced surveillance can be safely introduced in the National Health Service and is effective in reducing antibiotic use for EONS without increasing morbidity and mortality.

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Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-316777 ◽

2019 ◽

Vol 105 (2) ◽

pp. 118-122 ◽

Cited By ~ 9

Author(s):

Nitin Goel ◽

Sudeep Shrestha ◽

Rhian Smith ◽

Akshay Mehta ◽

Malini Ketty ◽

...

Keyword(s):

Neonatal Sepsis ◽

Early Onset ◽

Clinical Status ◽

Antibiotic Usage ◽

Relative Reduction ◽

Risk Calculator ◽

Kaiser Permanente ◽

Term Infants ◽

Maternity Hospitals ◽

Sepsis Risk

ObjectiveTo compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS).DesignMulticentre prospective observational projection study.SettingEight maternity hospitals in Wales, UK.PatientsAll live births ≥34 weeks gestation over a 3-month period (February–April 2018).MethodsDemographics, maternal and infant risk factors, infant’s clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC.Main outcome measureProportion of infants recommended for antibiotics on either tool.ResultsOf 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction of 74%. Of the 426 infants avoiding antibiotics, SRC assigned 314 (54.6%) to normal care only. There were seven positive blood cultures—three infants were recommended antibiotics by both, three were not identified in the asymptomatic stage by either; one was a contaminant. No EONS-related readmission was reported.ConclusionThe judicious adoption of SRC in UK clinical practice for screening and management of EONS could potentially reduce interventions and antibiotic usage in three out of four term or near-term infants and promote earlier discharge from hospital in >50%. We did not identify any EONS case missed by SRC when compared with NICE. These results have significant implications for healthcare resources.

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