Robert S. Baltimore, MD reviewing Kuzniewicz MW et al. JAMA Pediatr 2017 Feb 20.

A quantitative risk-based approach to assessing neonates resulted in fewer neonates being exposed to antibiotics compared with following nationally recognized guidelines.

In the first week of life, 15% to 20% of term and near-term newborns are evaluated for sepsis, and 5% to 8% are empirically treated for sepsis, despite a concurrent sepsis rate of only 0.3 to 0.8 per 1000 births. Existing guidelines are not specific in predicting early-onset sepsis (EOS). Investigators hypothesized that using a Bayesian approach to individualize the risk for sepsis, added to existing guidelines, could reduce rates of blood culture and unnecessary antibiotic exposure in neonates.

The authors used this approach for 204,485 infants born at ≥35 weeks' gestation at a hospital in one healthcare system during three sequential periods spanning 6 years. In the first (baseline) period, clinical care was informed by the Centers for Disease Control and Prevention guidelines for prevention of group B streptococcal infections in neonates. In the second (learning) period, clinicians used guidelines based only on maternal data. In the third (calculator) period, they added the neonate's clinical condition (i.e., well, equivocal, ill) to the estimation of sepsis risk based on prior clinical studies. Blood cultures were recommended if the EOS risk was ≥1 per 1000 live births and empirical antibiotics if EOS risk was ≥3 per 1000 live births.

In the third period, rates of evaluation for EOS and treatment with antibiotics were significantly lower than in the prior two periods. The sepsis rate and rate of adverse outcomes (including later presentation with sepsis) were unchanged after the introduction of the EOS calculator.

CITATION(S):

Kuzniewicz MW et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr 2017 Feb 20; [e-pub]. 

JWatch