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The Neonatal Early Onset Sepsis Calculator; in Clinical Practice.

L Loughlin1, S Knowles2, A Twomey1

  • 1Department of Neonatology, The National Maternity Hospital, Dublin 2.

Irish Medical Journal
|April 9, 2020
PubMed
Summary

The Neonatal Early Onset Sepsis Calculator (NEOSC) significantly reduced blood culture and antibiotic use in infants over 35 weeks gestational age. This implementation did not lead to an increase in sepsis infection rates.

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Area of Science:

  • Neonatal Medicine
  • Clinical Practice Guidelines
  • Infectious Disease Epidemiology

Background:

  • Neonatal sepsis poses a significant risk to infants, necessitating accurate diagnostic tools.
  • The Neonatal Early Onset Sepsis Calculator (NEOSC) is a multivariable risk prediction model designed for assessing sepsis risk in infants >35 weeks gestational age.
  • Evaluating the real-world impact of clinical decision support tools like the NEOSC is crucial for optimizing neonatal care.

Purpose of the Study:

  • To determine the impact of implementing the Neonatal Early Onset Sepsis Calculator (NEOSC) on clinical practice.
  • To assess changes in blood culture utilization and antibiotic prescribing following NEOSC adoption.
  • To evaluate the effect of NEOSC implementation on neonatal sepsis rates.

Main Methods:

  • A retrospective cohort study design was employed, comparing data from before and after NEOSC implementation.
  • Blood culture rates, infant antibiotic use, and sepsis rates were analyzed from January 2015 to Q1 2019.
  • Statistical analysis, including 95% confidence intervals, was used to assess the significance of observed changes.

Main Results:

  • A statistically significant reduction in blood culture use was observed post-NEOSC implementation (p < 0.00001).
  • Antibiotic use in the first 24 hours of life significantly decreased from 11.3% to 5.9% (p < 0.00001).
  • No significant differences were found in culture-confirmed GBS-sepsis or other-pathogen sepsis rates in term infants.

Conclusions:

  • The NEOSC effectively reduced the rates of blood culture collection and initial antibiotic administration in at-risk neonates.
  • Implementation of the NEOSC achieved these reductions without compromising patient safety, as evidenced by stable infection rates.
  • The NEOSC serves as a valuable tool for judicious antibiotic stewardship in neonatal care.