Agreement between an Early-Onset Neonatal Sepsis Risk Calculator and the Colombian Clinical Practice Guideline in Three Tertiary-Care Centers in Bogotá, Colombia

Abstract

Introduction: Clinical practice guidelines (CPG) worldwide help steer the management of early-onset neonatal sepsis (EONS). These documents typically discourage the use of risk assessment tools. However, prior work has shown that the Kaiser Permanente calculator (EOScalc) could be a useful tool in early-onset neonatal sepsis risk assessment. Aim: To determine the agreement between the recommendations of the Colombian EONS CPG and those of the EOSCalc tool in a cohort of newborns in Bogotá, Colombia. Methods: Multi-center retrospective observational cohort study. We included newborns with a gestational age ≥34 weeks who were admitted to the neonatal care unit with a suspected diagnosis of EONS between 2017-2019. Agreement between the two tools was examined using Cohen’s kappa under two scenarios (unequivocal and cautious). Results: Of the 23.490 live births, 470 (1.71%) were admitted to the neonatal care unit with a presumptive diagnosis of EONS. This diagnosis was confirmed in seven patients by means of blood cultures, with Group B Streptococcus as the most common organism (57% 95%CI 18.4-90.1). A single death occurred among the patients with confirmed EONS (lethality:14.3%). The overall incidence of EONS was of 0.298 per 1000 live births. After splitting the recommendations into two scenarios regarding antibiotic use, unequivocal and cautious, the agreement between EOSCalc and the CPG was below 15% (6% and 14%, respectively). Conclusions: Recommendations from the Colombian EONS CPG shows poor agreement with the EOSCalc, with the latter detecting all newborns with EONS. Although the use of EOSCalc is clinically and administratively advantageous, further prospective studies are warranted to determine the safety of its implementation. Keywords: Neonatal sepsis, newborn, Early-Onset Sepsis Calculator, Practice Guideline.