Management of well appearing infants born to afebrile mothers with inadequate GBS prophylaxis: A retrospective comparison of the three approaches recommended by the COFN

2021 ◽  
pp. 1-6
Author(s):  
T. Beck ◽  
A.J. Sloane ◽  
D.L. Carola ◽  
D. McElwee ◽  
C. Edwards ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Risk Factor ◽  
Clinical Condition ◽  
Early Onset ◽  
Vital Signs ◽  
Newborn Care ◽  
Kaiser Permanente ◽  
Multivariate Risk ◽  
Early Onset Sepsis ◽  
Group B

BACKGROUND: There are three different approaches set forth by the Committee on the Fetus and Newborn (COFN) for managing asymptomatic neonates born to mothers with inadequate intrapartum antibiotic prophylaxis (IAP) for early-onset Group B Strep (GBS) infection. The first approach is that of categorical risk factor assessments, and recommends that asymptomatic infants born to afebrile mothers with inadequate IAP for GBS be monitored with clinical observation for 36–48 hours. The second approach recommends serial physical examinations and vital signs for 36–48 hours to closely monitor changes in clinical condition for all patients. The Kaiser Permanente EOS risk calculator (SRC) is an example of the third approach, a multivariate risk assessment, and it takes into consideration several perinatal risk factors. This multivariate risk assessment then provides recommendations for reassessment and management based on presume risk of the infant developing or having Early Onset Sepsis (EOS). The aim of our study was to compare these three recently published recommendations from the COFN for the management of asymptomatic neonates born to afebrile mothers with inadequate IAP for GBS. STUDY DESIGN: This is a retrospective study of asymptomatic neonates with gestational age ≥35 weeks born to afebrile mothers with indicated inadequate IAP for GBS between April 2017 and July 2020. Management recommendations of the SRC were compared to the recommendations of categorical risk assessment and risk assessment based on clinical condition. RESULTS: A total of 7,396 infants were born during the study period, 394 (5.3%. to mothers with inadequate IAP. Recommendations for these infants according to both the categorical risk factor guideline and the clinical condition guideline include extended, close observation. However, the SRC recommended routine newborn care for 99.7%.f these infants. None of the infants developed EOS. CONCLUSION: The SRC recommend routine neonatal care without enhanced and prolonged observation for nearly all asymptomatic infants born to afebrile mothers with inadequate IAP. As none of the infants in this cohort had EOS, further studies in a larger cohort are needed to establish the safety of SRC in neonates born to mothers with inadequate IAP.

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 To screen or not to screen women for Group B Streptococcus (Streptococcus agalactiae) to prevent early onset sepsis in newborns: recent advances in the unresolved debate

2020 ◽  
Vol 7 ◽  
pp. 204993612094242
Author(s):  
Guduru Gopal Rao ◽  
Priya Khanna
Keyword(s):  
Risk Factor ◽  
Antimicrobial Resistance ◽  
Low Income ◽  
Streptococcus Agalactiae ◽  
Early Onset ◽  
Group B Streptococcus ◽  
Developed Countries ◽  
Low Income Countries ◽  
Early Onset Sepsis ◽  
Group B

Streptococcus agalactiae, also known as Group B streptococcus (GBS) is the commonest cause of early onset sepsis in newborns in developed high-income countries. Intrapartum antimicrobial (antibiotic) prophylaxis (IAP) is recognized to be highly effective in preventing early onset Group B sepsis (EOGBS) in newborns. The key controversy is about the strategy that should be used to identify mothers who should receive IAP. There are two strategies that are followed in developed countries: screening-based or risk-factor-based identification of women requiring IAP. The debate regarding which of the two approaches is better has intensified in the recent years with concerns about antimicrobial resistance, effect on newborn’s microbiome and other adverse effects. In this review, we have discussed some of the key research papers published in the period 2015–2019 that have addressed the relative merits and disadvantages of screening versus risk-factor-based identification of women requiring IAP. Although screening-based IAP appears to be more efficacious than risk-based IAP, IAP-based prevention has several limitations including ineffectiveness in prevention of late-onset GBS infection in babies, premature and still births, impact of IAP on neonatal microbiota, emergence of antimicrobial resistance and difficulties in implementing IAP-based strategies in middle and low income countries. Alternative strategies, principally maternal immunization against GBS would circumvent use of IAP. However, no licensed vaccines are currently available for use.

Management of infants born to mothers with chorioamnionitis: A retrospective comparison of the three approaches recommended by the committee on fetus and newborn

2020 ◽  
pp. 1-8
Author(s):  
A.J. Sloane ◽  
D.L. Carola ◽  
M.A. Lafferty ◽  
C. Edwards ◽  
J. Greenspan ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Antibiotic Therapy ◽  
Clinical Condition ◽  
Vital Signs ◽  
Antibiotic Use ◽  
Risk Assessments ◽  
Empiric Antibiotic Therapy ◽  
Early Onset Sepsis ◽  
Increased Risk ◽  
Empiric Antibiotic

BACKGROUND: Based on the most recently published recommendations from the Committee on the Fetus and Newborn (COFN), three approaches currently exist for the use of risk factors to identify infants who are at increased risk of early-onset sepsis (EOS). Categorical risk factor assessments recommend laboratory testing and empiric antibiotic therapy for all infants born to mothers with a clinical diagnosis of chorioamnionitis. Risk assessments based on clinical condition recommend frequent examinations and close vital sign monitoring for infants born to mothers with chorioamnionitis. The Kaiser Permanente EOS risk calculator (SRC) is an example of the third approach, multivariate risk assessments. The aim of our study was to compare the three risk stratification approaches recommended by the COFN for management of chorioamnionitis-exposed infants. METHODS: Retrospective study of 1,521 infants born ≥35 weeks to mothers with chorioamnionitis. Management recommendations of the SRC were compared to the recommendations of categorical risk assessment and risk assessment based on clinical condition (CCA). RESULTS: Hypothetical application of SRC and CCA resulted in 79.6% and 76.8–85.1% respectively fewer infants allocated empiric antibiotic therapy. While CCA recommended enhanced observation for all chorioamnionitis-exposed infants, SRC recommended routine care without enhanced observation in 44.3% infants. For the six infants (0.39%) with EOS, SRC and CCA recommended empiric antibiotics only for three symptomatic infants. CONCLUSION: The SRC and CCA can reduce antibiotic use but potentially delay antibiotic treatment. The SRC does not recommend enhanced observation with frequent and prolonged vital signs for >44% of chorioamnionitis-exposed infants.

The Use of Blood Counts and Blood Cultures to Screen Neonates Born to Partially Treated Group B Streptococcus-carrier Mothers for Early-onset Sepsis

2011 ◽  
Vol 30 (10) ◽  
pp. 840-843 ◽  
Author(s):  
Saar Hashavya ◽  
Shmuel Benenson ◽  
Zivanit Ergaz-Shaltiel ◽  
Benjamin Bar-Oz ◽  
Diana Averbuch ◽  
...  
Keyword(s):  
Early Onset ◽  
Group B Streptococcus ◽  
Treated Group ◽  
Blood Cultures ◽  
Early Onset Sepsis ◽  
Group B

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.

scholarly journals P037 Evaluating the introduction of dose banded cefotaxime using pre- filled syringes, for early onset sepsis on a neonatal unit

2019 ◽  
Vol 104 (7) ◽  
pp. e2.42-e2
Author(s):  
Suzannah Hibberd
Keyword(s):  
Early Onset ◽  
Electronic Prescribing ◽  
Drug Preparation ◽  
List Type ◽  
Nice Guideline ◽  
Batch Number ◽  
Early Onset Sepsis ◽  
Mandatory Requirement ◽  
Group A ◽  
Group B

BackgroundIn December 2017, cefotaxime doses for treatment of early onset sepsis were banded according to weight. The dose-banding only applies to neonates <7 days old. The implementation of pre-filled syringes (PFS) supplied by the Pharmacy Technical Services Unit coincided with the introduction of cefotaxime dose-banding.AimTo assess whether cefotaxime is prescribed according to the dose-banding guideline. To establish if batch numbers of PFS are reconciled on the electronic prescribing system (EPS). To determine whether introducing PFS has resulted in more neonates receiving the first dose of antibiotics within 1 hour of the decision to treat.MethodsAn EPS report was generated for 2 groups of patients. Group A received cefotaxime from April to June 2018, group B received cefotaxime from September to November 2017, before dose-banding was introduced. Data collected included: weight; dose; time of prescribing and time of administration for the first dose; whether a PFS was used and if the batch number was reconciled electronically. Patients transferred into the unit were excluded as they had started their antibiotics prior to transfer.Results95.3% of group A, (n=85), received doses in accordance with the guideline, two doses were prescribed according to weight. Out of the 95.3% eligible to receive PFS, 91.4% of PFS were documented on the EPS. It was unknown whether PFS were used for the remaining patients. 90.5% of the PFS batch numbers were reconciled, 8.1% were not reconciled and 1.4% had incomplete records. 81.2% of group A received the first dose of antibiotics ≤60 minutes from the point of prescribing in comparison to 76.6% in group B (n=94). 58.8% of group A and 42.6% of group B had doses administered ≤30 minutes after prescribing. Both groups had 5 patients that did not receive their first dose until >2 hours after prescribing.ConclusionThe majority of prescribers are using the dose- banding guideline. 91.4% of doses have been administered using PFS, thereby reducing nursing time used for IV drug preparation. In 8.6% it could not be determined whether a PFS was used although prescription templates had been used. The template includes a mandatory box to say if a PFS has been used, nurses cannot sign the drug administration if it is empty. An outcome from this study is that this discrepancy will be investigated by the electronic prescribing team. Nurses are recording batch numbers onto the EPS in 90.5% of cases. Nurses will be reminded to reconcile batch numbers and making it a mandatory requirement on the EPS will be investigated Having PFS available has led to more patients receiving their dose within 30 minutes and slightly more receiving their doses within 60 minutes. However similar numbers are still receiving their doses >60 minutes after prescribing. Next steps will be to examine cases where antibiotics are delayed and identify causes. A limitation of this study is that it does not take into account how long it takes the prescriber to write the prescription after making the decision to treat.ReferenceNational Institute for Health and Clinical Excellence. ( 2012) Neonatal Infection (early onset): antibiotics for prevention and treatment. NICE Guideline (CG149)

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