Implementation of a clinical guideline to decrease laboratory tests in newborns evaluated for early onset sepsis.

Area of Science:

• Neonatal Medicine
• Clinical Practice Guidelines
• Pediatric Infectious Diseases

Background:

• Maternal chorioamnionitis is a common reason for neonatal intensive care unit (NICU) admission.
• Early onset sepsis (EOS) evaluation in neonates often involves extensive laboratory testing, including complete blood counts (CBCs).
• Over-testing can lead to unnecessary procedures and costs for healthy infants.

Purpose of the Study:

• To implement and evaluate a clinical guideline aimed at reducing CBCs in neonates with maternal chorioamnionitis.
• To assess the impact of the guideline on EOS evaluation protocols.
• To maintain patient safety while optimizing resource utilization.

Main Methods:

• A clinical guideline was introduced across four NICUs.
• Key metrics monitored included CBC frequency and timing, culture-negative sepsis rates, length of stay, and readmission rates.
• Data were collected and analyzed to compare outcomes before and after guideline implementation.

Main Results:

• A significant decrease in the mean number of CBCs per patient was observed (from 2.31±0.62 to 1.52±0.65).
• No increase in culture-negative sepsis, length of stay, or readmission rates was detected.
• The guideline effectively reduced laboratory utilization without compromising patient care.

Conclusions:

• The implemented clinical guideline successfully reduced CBCs in well-appearing infants admitted for EOS evaluation due to maternal chorioamnionitis.
• This strategy demonstrates a safe and effective method for optimizing diagnostic testing in neonates.
• The findings support the adoption of similar guidelines to improve efficiency in neonatal care.