scholarly journals Early-Onset Sepsis Risk Calculator: A Review Of Its Effectiveness And Comparative Study With Our Evidence-Based Local Guidelines

2021 ◽  
Author(s):  
Gianluigi Laccetta ◽  
Massimiliano Ciantelli ◽  
Cristina Tuoni ◽  
Emilio Sigali ◽  
Mario Miccoli ◽  
...  
Keyword(s):  
Gestational Age ◽  
Early Onset ◽  
Clinical Signs ◽  
Risk Calculator ◽  
Live Births ◽  
Early Onset Sepsis ◽  
Number Of Patients ◽  
Sepsis Risk ◽  
Empirical Antibiotics ◽  
Sepsis Calculator

Abstract Background According to most early-onset sepsis management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. Early-onset sepsis risk calculator has been developed with the purpose of avoiding antibiotic overtreatment among neonates ≥ 34 weeks’ gestational age: a review of literature demonstrates its effectiveness in reducing antibiotic overtreatment, laboratory testing, painful procedures and NICU admission; however, some missed cases of culture-positive early-onset sepsis have also been described. Methods All neonates with birth weight ≤ 1500 g, 34–36 weeks’ gestational age neonates with suspected intraamniotic infection and neonates with three clinical signs of early-onset sepsis or two signs and one risk factor for early-onset sepsis receive empirical antibiotics. Neonates ≥ 34 weeks’ gestational age with risk factors for early-onset sepsis or with one clinical indicator of early-onset sepsis undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 hours of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of early-onset sepsis. We therefore compared the number of patients for which antibiotics were needed, based on early-onset sepsis calculator, and the number of patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05. Results During the study period (1st January 2018-31st December 2018) 32/265 (12.1%) neonates ≥ 34 weeks’ gestational age at risk for early-onset sepsis received antibiotics within the first 12 hours of life. According to early-onset sepsis calculator: 55/265 (20.7%) patients would have received antibiotics with early-onset sepsis incidence 2/1000 live births (p < 0.0001); 44/265 (16.6%) patients would have received antibiotics with early-onset sepsis incidence 0.1/1000 live births (p < 0.025). One patient with culture-negative early-onset sepsis would not have received antibiotics with an early-onset sepsis incidence of 0.1/1000 live births. Conclusion Our evidence-based protocol for treatment decision-making of neonatal early-onset sepsis entails a further decrease of antibiotic overtreatment compared to early-onset sepsis risk calculator. No negative consequences for patients were observed.

scholarly journals Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Gianluigi Laccetta ◽  
Massimiliano Ciantelli ◽  
Cristina Tuoni ◽  
Emilio Sigali ◽  
Mario Miccoli ◽  
...  
Keyword(s):  
Early Onset ◽  
Statistical Significance ◽  
Clinical Signs ◽  
Evidence Based ◽  
Negative Consequences ◽  
Subsequent Increase ◽  
Early Onset Sepsis ◽  
Number Of Patients ◽  
Group A ◽  
Empirical Antibiotics

Abstract Background According to most early-onset sepsis (EOS) management guidelines, approximately 10% of the total neonatal population are exposed to antibiotics in the first postnatal days with subsequent increase of neonatal and pediatric comorbidities. A review of literature demonstrates the effectiveness of EOS calculator in reducing antibiotic overtreatment and NICU admission among neonates ≥34 weeks’ gestational age (GA); however, some missed cases of culture-positive EOS have also been described. Methods Single-center retrospective study from 1st January 2018 to 31st December 2018 conducted in the Division of Neonatology at Santa Chiara Hospital (Pisa, Italy). Neonates ≥34 weeks’ GA with birth weight ≤ 1500 g, 34–36 weeks’ GA neonates with suspected intraamniotic infection and neonates ≥34 weeks’ GA with three clinical signs of EOS or two signs and one risk factor for EOS receive empirical antibiotics. Neonates ≥34 weeks’ GA with risk factors for EOS or with one clinical indicator of EOS undergo serial measurements of C-reactive protein and procalcitonin in the first 48–72 h of life; they receive empirical antibiotics in case of abnormalities at blood exams with one or more clinical signs of EOS. Two hundred sixty-five patients at risk for EOS met inclusion criteria; they were divided into 3 study groups: 34–36 weeks’ GA newborns (n = 95, group A), ≥ 37 weeks’ GA newborns (n = 170, group B), and ≥ 34 weeks’ GA newborns (n = 265, group A + B). For each group, we compared the number of patients for which antibiotics would have been needed, based on EOS calculator, and the number of the same patients we treated with antibiotics during the study period. Comparisons between the groups were performed using McNemar’s test and statistical significance was set at p < 0.05; post-hoc power analysis was carried out to evaluate the sample sizes. Results 32/265 (12.1%) neonates ≥34 weeks’ GA received antibiotics within the first 12 h of life. According to EOS calculator 55/265 (20.7%) patients would have received antibiotics with EOS incidence 2/1000 live births (p < 0.0001). Conclusion Our evidence-based protocol entails a further decrease of antibiotic overtreatment compared to EOS calculator. No negative consequences for patients were observed.

A comparison between risk-factor guidance for neonatal early-onset sepsis and Kaiser Permanente sepsis risk calculator in a Greek cohort

2021 ◽  
Vol 155 ◽  
pp. 105331
Author(s):  
Dimitrios Rallis ◽  
Foteini Balomenou ◽  
Konstantina Karantanou ◽  
Kleio Kappatou ◽  
Meropi Tzoufi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Early Onset ◽  
Risk Calculator ◽  
Kaiser Permanente ◽  
Early Onset Sepsis ◽  
Sepsis Risk

scholarly journals Relevance of Biomarkers Currently in Use or Research for Practical Diagnosis Approach of Neonatal Early-Onset Sepsis

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 309
Author(s):  
Maura-Adelina Hincu ◽  
Gabriela-Ildiko Zonda ◽  
Gabriela Dumitrita Stanciu ◽  
Dragos Nemescu ◽  
Luminita Paduraru
Keyword(s):  
High Mortality ◽  
Early Onset ◽  
Clinical Signs ◽  
Developed Countries ◽  
Extremely Low Birth Weight ◽  
Invasive Infection ◽  
Acute Phase Reactants ◽  
Hematological Indices ◽  
Live Births ◽  
Early Onset Sepsis

Neonatal early-onset sepsis (EOS) is defined as an invasive infection that occurs in the first 72 h of life. The incidence of EOS varies from 0.5–2% live births in developed countries, up to 9.8% live births in low resource settings, generating a high mortality rate, especially in extremely low birth weight neonates. Clinical signs are nonspecific, leading to a late diagnosis and high mortality. Currently, there are several markers used for sepsis evaluation, such as hematological indices, acute phase reactants, cytokines, which by themselves do not show acceptable sensitivity and specificity for the diagnosis of EOS in neonates. Newer and more selective markers have surfaced recently, such as presepsin and endocan, but they are currently only in the experimental research stages. This comprehensive review article is based on the role of biomarkers currently in use or in the research phase from a basic, translational, and clinical viewpoint that helps us to improve the quality of neonatal early-onset sepsis diagnosis and management.

Utility of Early-Onset Sepsis Risk Calculator for Neonates Born to Mothers with Chorioamnionitis

2018 ◽  
Vol 195 ◽  
pp. 48-52.e1 ◽  
Author(s):  
David Carola ◽  
Mansi Vasconcellos ◽  
Amy Sloane ◽  
Dorothy McElwee ◽  
Caroline Edwards ◽  
...  
Keyword(s):  
Early Onset ◽  
Risk Calculator ◽  
Early Onset Sepsis ◽  
Sepsis Risk

Implementation and Evaluation of the Early-Onset Sepsis Risk Calculator in a High-Risk University Nursery

2017 ◽  
Vol 57 (9) ◽  
pp. 1080-1085 ◽  
Author(s):  
Jessica B. Beavers ◽  
Shasha Bai ◽  
Jennifer Perry ◽  
Jordan Simpson ◽  
Sara Peeples
Keyword(s):  
Early Onset ◽  
Neonatal Intensive Care ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Risk Calculator ◽  
Admission Rates ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Control And Prevention ◽  
Nicu Admission

There is growing interest in the Kaiser early-onset sepsis (EOS) risk calculator though institutions are hesitant to deviate from the Centers for Disease Control and Prevention guidelines and implement this in their hospitals. We describe the process of implementing routine use of the risk calculator in term and late preterm newborns delivered to mothers with chorioamnionitis in a level III neonatal intensive care unit (NICU). A retrospective chart review of infants delivered to mothers with chorioamnionitis from 2011 to 2014 was performed. Implementation of routine use of the calculator began in January 2015; preintervention and postintervention data were analyzed after a 9-month period of routine use. Following implementation, NICU admission rates, number of blood cultures drawn, and rates of antibiotic use dropped by 54%, 42%, and 59%, respectively ( P < .001). No negative outcomes were reported. In this article, we describe how the calculator was safely implemented in our NICU while decreasing the number of interventions.

scholarly journals A sepsis risk calculator can decrease antibiotic exposure in neonatal early‐onset sepsis screening

2020 ◽  
Vol 109 (10) ◽  
pp. 2166-2167
Author(s):  
Rebeca Cavazos ◽  
Monika Patil ◽  
K. Suresh Gautham
Keyword(s):  
Early Onset ◽  
Antibiotic Exposure ◽  
Risk Calculator ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Sepsis Screening

Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with NICE guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis

2020 ◽  
Vol 105 (6) ◽  
pp. 581-586
Author(s):  
Rachel Morris ◽  
Steve Jones ◽  
Sujoy Banerjee ◽  
Andrew Collinson ◽  
Hannah Hagan ◽  
...  
Keyword(s):  
Early Onset ◽  
Risk Calculator ◽  
Kaiser Permanente ◽  
Nice Guideline ◽  
Early Onset Sepsis ◽  
Nice Guidance ◽  
Sepsis Risk ◽  
Cerebrospinal Fluid Culture ◽  
Management Recommendations ◽  
Fluid Culture

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.

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

2021 ◽  
pp. 000992282110647
Author(s):  
Sharmila Oak ◽  
Melanie Stempowski ◽  
Erin Frank
Keyword(s):  
Early Onset ◽  
Antibiotic Use ◽  
Culture Collection ◽  
Risk Calculator ◽  
Community Based ◽  
Exact Test ◽  
Early Onset Sepsis ◽  
Sepsis Risk ◽  
Level 1 ◽  
Level I

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.

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