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Newborn antibiotic exposure in hospitals varies widely and is not linked to bloodstream infections. Sepsis identification is often inefficient, highlighting the need for better diagnostic strategies in neonatal care.

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Area of Science:

  • Neonatal Medicine
  • Infectious Disease Epidemiology
  • Healthcare Quality Improvement

Background:

  • Antibiotic use in newborns is common but varies significantly across hospitals.
  • Effective diagnosis of bloodstream infections (BSI) in neonates is crucial for appropriate treatment and outcomes.

Purpose of the Study:

  • To determine the percentage of hospital births receiving antibiotics before discharge.
  • To assess the efficiency of diagnosing proven bloodstream infections in relation to antibiotic exposure.

Main Methods:

  • Cross-sectional study of 326,845 live births in 2017 across 121 California hospitals with NICUs.
  • Analyzed antibiotic exposure (intravenous or intramuscular) during inpatient stay.
  • Correlated antibiotic exposure rates with bloodstream infection rates, surgical volume, NICU admissions, and mortality.

Main Results:

  • Newborn antibiotic exposure ranged from 1.6% to 42.5% (mean 8.5%), with significant inter-hospital variation.
  • Antibiotic exposure did not correlate with proven bloodstream infection rates.
  • The number of infants receiving antibiotics per sepsis case varied widely, indicating diagnostic inefficiencies.

Conclusions:

  • Wide variation in newborn antibiotic exposure is not explained by bloodstream infection rates.
  • Sepsis identification, especially early-onset, is often inefficient.
  • Quantifying antibiotic exposure provides a complementary measure to days of exposure for evaluating care.