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Updated: Jul 4, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Resource Utilization and Costs Associated with Approaches to Identify Infants with Early-Onset Sepsis
Grace Guan1, Neha S Joshi2, Adam Frymoyer2
1Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
Insights
The neonatal sepsis calculator and enhanced clinical observation are preferred for identifying early-onset sepsis (EOS) in newborns. These methods reduce infant antibiotic exposure and interventions compared to categorical risk assessment, despite similar overall costs.
Area of Science:
- Neonatal medicine
- Public health
- Health economics
Background:
- The American Academy of Pediatrics (AAP) recommends 3 approaches for identifying early-onset sepsis (EOS) in infants born at ≥35 weeks gestational age.
- Evaluating resource utilization and costs of these screening methods is crucial for healthcare systems.
Purpose of the Study:
- To compare resource utilization and costs of 3 AAP-recommended screening approaches for early-onset sepsis (EOS).
- To identify the most cost-effective and resource-efficient screening strategy for EOS.
Main Methods:
- Decision tree-based cost analysis comparing 3 AAP-recommended EOS screening approaches: categorical risk assessment, neonatal sepsis calculator, and enhanced clinical observation.
- Evaluation of resource utilization (e.g., NICU days) and direct health system costs in 2022 US dollars.
Main Results:
- Categorical risk assessment resulted in higher NICU usage (210 days/1,000 live births) and antibiotic exposure (6.8%) compared to the neonatal sepsis calculator (112 days/1,000 live births, 3.6%) and enhanced clinical observation (99 days/1,000 live births, 3.1%).
- While per-live birth costs were similar ($1,360 vs $1,317 vs $1,310), intervention costs under categorical risk assessment were double those of the other two strategies.
- Results remained robust across data variations.
Conclusions:
- Neonatal sepsis calculator and enhanced clinical observation are preferable to categorical risk assessment for EOS screening.
- These preferred approaches reduce infant intervention rates, antibiotic exposure, and associated costs.
- Further cost-effectiveness analyses should consider downstream effects of neonatal antibiotic exposure.
Abstract:
Objective. To compare resource utilization and costs associated with 3 alternative screening approaches to identify early-onset sepsis (EOS) in infants born at ≥35 wk of gestational age, as recommended by the American Academy of Pediatrics (AAP) in 2018. Study Design. Decision tree-based cost analysis of the 3 AAP-recommended approaches: 1) categorical risk assessment (categorization by chorioamnionitis exposure status), 2) neonatal sepsis calculator (a multivariate prediction model based on perinatal risk factors), and 3) enhanced clinical observation (assessment based on serial clinical examinations). We evaluated resource utilization and direct costs (2022 US dollars) to the health system. Results. Categorical risk assessment led to the greatest neonatal intensive care unit usage (210 d per 1,000 live births) and antibiotic exposure (6.8%) compared with the neonatal sepsis calculator (112 d per 1,000 live births and 3.6%) and enhanced clinical observation (99 d per 1,000 live births and 3.1%). While the per-live birth hospital costs of the 3 approaches were similar-categorical risk assessment cost $1,360, the neonatal sepsis calculator cost $1,317, and enhanced clinical observation cost $1,310-the cost of infants receiving intervention under categorical risk assessment was approximately twice that of the other 2 strategies. Results were robust to variations in data parameters. Conclusion. The neonatal sepsis calculator and enhanced clinical observation approaches may be preferred to categorical risk assessment as they reduce the number of infants receiving intervention and thus antibiotic exposure and associated costs. All 3 approaches have similar costs over all live births, and prior literature has indicated similar health outcomes. Inclusion of downstream effects of antibiotic exposure in the neonatal period should be evaluated within a cost-effectiveness analysis.
Highlights:
Of the 3 approaches recommended by the American Academy of Pediatrics in 2018 to identify early-onset sepsis in infants born at ≥35 weeks, the categorical risk assessment approach leads to about twice as many infants receiving evaluation to rule out early-onset sepsis compared with the neonatal sepsis calculator and enhanced clinical observation approaches.While the hospital costs of the 3 approaches were similar over the entire population of live births, the neonatal sepsis calculator and enhanced clinical observation approaches reduce antibiotic exposure, neonatal intensive care unit admission, and hospital costs associated with interventions as part of the screening approach compared with the categorical risk assessment approach.
