Use of an Early Onset-Sepsis Calculator to Decrease Unnecessary NICU Admissions and Increase Exclusive Breastfeeding

Area of Science:

• Neonatal care
• Infectious disease epidemiology
• Quality improvement in healthcare

Background:

• Chorioamnionitis exposure in term neonates often leads to NICU admission, extensive testing, and antibiotic use.
• Current practices may result in unnecessary interventions and separation of mother-neonate dyads.
• There is a need for evidence-based tools to guide management of neonates exposed to chorioamnionitis.

Purpose of the Study:

• To assess the impact of the Kaiser Neonatal Early-Onset Sepsis Calculator (NEOSC) on clinical outcomes.
• To evaluate changes in NICU admissions, laboratory testing, and antibiotic exposure.
• To determine the effect on exclusive breastfeeding (EBF) rates in term neonates exposed to chorioamnionitis.

Main Methods:

• Quality improvement project utilizing retrospective data review.
• Implementation of the Kaiser NEOSC for risk assessment in term neonates exposed to chorioamnionitis.
• Comparison of pre- and post-intervention data on NICU admissions, laboratory tests, antibiotic use, and EBF.

Main Results:

• NICU admissions, laboratory testing, and antibiotic use decreased significantly after NEOSC implementation.
• Among neonates exposed to chorioamnionitis, 93% were not admitted to the NICU, and only 11% required laboratory evaluation.
• Exclusive breastfeeding (EBF) rates increased from <10% to >50%, with a reduction in NICU stay length from 138 to 12 days.

Conclusions:

• The Kaiser NEOSC effectively identified well-appearing neonates exposed to chorioamnionitis who did not require NICU admission or treatment.
• Implementation of the NEOSC led to improved EBF rates and reduced adverse outcomes like painful interventions and separation.
• The practice change demonstrated a safe and beneficial approach to managing neonates exposed to chorioamnionitis.