Early-onset sepsis: a cohort study comparing serial clinical observation with laboratory testing

Area of Science:

• Neonatal Medicine
• Infectious Disease Management
• Clinical Protocol Development

Background:

• Early onset sepsis (EOS) poses a significant threat to neonates.
• Current diagnostic and treatment protocols often lead to extensive laboratory evaluations and antibiotic overuse.
• There is a need for strategies that balance timely diagnosis with reduced interventions.

Purpose of the Study:

• To evaluate the feasibility and impact of serial clinical observation (SCO) for managing neonates at risk for EOS.
• To compare laboratory evaluations and antibiotic use in neonates managed with SCO versus traditional laboratory testing.
• To assess the effect of SCO on diagnosis timeliness and mother-infant bonding.

Main Methods:

• A prospective cohort study comparing neonates managed with SCO (n=381) to a historical cohort (n=417) who underwent laboratory testing.
• Focus on neonates ≥35 weeks' gestation at risk for EOS, including those exposed to chorioamnionitis.
• Data collection on admissions for suspected sepsis and antibiotic therapy duration.

Main Results:

• Significant reduction in admissions for suspected sepsis (7.2% vs 2.9%, p=0.006) in the SCO cohort.
• Marked decrease in antibiotic use (6.1% vs 0.7%, p=0.000) with SCO implementation.
• No delay in the diagnosis of EOS was observed in the SCO group.

Conclusions:

• Serial clinical observation (SCO) is a feasible strategy for managing neonates at risk for EOS.
• SCO effectively reduces laboratory evaluations and unnecessary antibiotic exposure.
• This approach respects mother-infant bonding while ensuring timely and appropriate care.