Infants Born to Mothers with Clinical Chorioamnionitis: A Cross-Sectional Survey on the Use of Early-Onset Sepsis Risk Calculator and Prolonged Use of Antibiotics

Ayrapetyan, Marina; Carola, David; Lakshminrusimha, Satyanarayana; Bhandari, Vineet; Aghai, Zubair H.

doi:10.1055/s-0038-1668548

Cited by 21 publications

(18 citation statements)

References 22 publications

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“…This hypothesis is further supported by a recent theoretical costbenefit analysis, which estimated a net monetary benefit of $3998 per infant with a 60% likelihood of net benefit in a US setting [7]. To our knowledge, despite signs of significant uptake [8] and multiple reports on adoption of the EOS calculator [3,9,10], no real-world evidence of the effect of EOS calculator use on financial costs associated with healthcare for suspected EOS has been published.…”

Section: Introductionmentioning

confidence: 71%

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

et al. 2020

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The neonatal early onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction of empiric antibiotic treatment for suspected EOS. We studied if implementation of the EOS calculator results in less healthcare utilization and lower financial costs of suspected EOS. For this, we compared two single-year cohorts of hospitalizations within 3 days after birth in a Dutch nonacademic teaching hospital, before and after implementation of the EOS calculator. All admitted newborns born at or after 35 weeks of gestation were eligible for inclusion. We analyzed data from 881 newborns pre-implementation and 827 newborns post-implementation. We found significant reductions in EOS-related laboratory tests performed and antibiotic days, associated with implementation of the EOS calculator. Mean length of hospital stay was shorter, and EOS-related financial costs were lower after implementation among term, but not among preterm newborns.Conclusion: In addition to the well-known positive impact on antibiotic stewardship, implementation of the EOS calculator is also clearly associated with reductions in healthcare utilization related to suspected EOS in late preterm and term newborns and with a reduction in associated financial costs among those born term.What is Known: • The early-onset sepsis (EOS) calculator is a novel tool for antibiotic stewardship in newborns, associated with a reduction in empiric antibiotic treatment for suspected EOS. What is New:• In newborns at risk for EOS, EOS calculator implementation is associated with a significant reduction in laboratory investigations related to suspected EOS and significantly shorter stay in those born term. • EOS calculator implementation in term newborns is associated with a mean reduction of €207 in costs for EOS-related care per admitted newborn.

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Section: Introductionmentioning

confidence: 71%

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

et al. 2020

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“…Ayerapetyan, 2019 116 Kasdorf, 2015 107 Natarajan, 2013 108 Sarkar, 2010 109 Shah, 2015 110 Shibasaki, 2020 112 Sproat, 2017 111 Zhang, 2019 117 Zhong 116 Casalaz, 1998 104 Harrington, 2007 103 Kasdorf, 2015 107 Natarajan, 2013 108 Patel, 2004 114 Sarkar, 2010 109 Shah, 2015 110 Shibasaki, 2020 112 Sproat, 2017 111 Zhang, 2019 117 Zhong 104 Harrington, 2007 103 Shah, 2015 110 Sproat, 2017 111 Zhang, 2019 117 Zhong, 2019 113 Note: Neurodevelopmental outcomes in postdischarge follow-up were reported in 13 studies using structured exams. 103,104,106À 112,114 À 117 In 11 studies, these assessments used validated developmental assessment tools.…”

Section: Therapeutic Hypothermiamentioning

confidence: 99%

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Wyckoff¹,

Wyllie²,

Aziz³

et al. 2020

Resuscitation

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With TreatmentRecommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates.The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid.Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed.All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published.Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.

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“…In our study, 45/52 of preterm (PT) <34 weeks neonates (86.5%), 21/32 of late preterm (LPT) neonates (65.6%), and 44/85 of full term (FT) neonates (51.7%) were hospitalized and treated. Also, the need for hospitalization and antibiotic therapy can be reduced by physical examination of the asymptomatic LPT and FT neonates, 33 or using the Sepsis Risk Calculator (SRC), 34,35 and in PT neonates (≤34 weeks) based on AAP guideline. 17 However, the results depend on future clinical studies.…”

Section: Antibiotic In Neonatesmentioning

confidence: 99%

Chorioamnionitis and Neonates; Which Strategy?

et al. 2020

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Background: Chorioamnionitis (CAM) is one of the major risk factors for neonatal early-onset sepsis (EOS). Different international guidelines have been developed for diagnosis and care of such neonates. This research aimed to evaluate our neonates and compare them with the guidelines. Methods: This prospective cohort study was conducted during five years (March 2012 to March 2017), and comprised of neonates (any gestational age) born to mothers with CAM (any criteria). The neonates’ clinical findings and interventions were collected and analyzed. Results: In total, out of 28,988 live born neonates, CAM was found in mothers of 169 neonates (1.7%). Among the studied neonates, 30.8% were born ≤34 week of gestation, 39% had birth weight <2500 g, and 58.6% were asymptomatic. Out of 99 asymptomatic neonates, 47 were observed near mothers and 52 admitted to the neonatal intensive care unit (NICU). The frequency of abnormal tests was 23.07% in asymptomatic vs. 35.7% in symptomatic neonates; three neonates developed culture positive EOS (2.75%) and 68.05% of the neonates received antibiotics. The length of stay was 2.59 ± 1.13 (median = 2.00, IQR = 1.00) days in asymptomatic vs. 15.15 ± 13.67 (median = 7.00, IQR = 15.25) days in symptomatic neonates (P<0.001). Conclusion: The use of guidelines increased the length of stay, lab tests, and antibiotics in asymptomatic and neonates with negative blood culture. In addition to the mother-neonate separation, these guidelines may increase nosocomial infection, antibiotic resistance, and costs; therefore, new guidelines are needed to be developed.

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Infants Born to Mothers with Clinical Chorioamnionitis: A Cross-Sectional Survey on the Use of Early-Onset Sepsis Risk Calculator and Prolonged Use of Antibiotics

Cited by 21 publications

References 22 publications

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Chorioamnionitis and Neonates; Which Strategy?

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