Should we give antibiotics to neonates with mild non-progressive symptoms? A comparison of serial clinical observation and the neonatal sepsis risk calculator

Abstract

ObjectiveTo compare two strategies [the neonatal sepsis risk calculator (NSC) and the updated serial clinical observation approach (SCO)] for the management of asymptomatic neonates at risk of early-onset sepsis (EOS) and neonates with mild non-progressive symptoms in the first hours of life.MethodsThis was a single-center, retrospective cohort study conducted over 15 months (01/01/2019–31/03/2020). All live births at ≥34 weeks of gestation were included. Infants were managed using SCO and decisions were compared with those retrospectively projected by the NSC. The proportion of infants recommended for antibiotics or laboratory testing was compared in both strategies. McNemar's non-parametric test was used to assess significant differences in matched proportions.ResultsAmong the 3,445 neonates (late-preterm, n = 178; full-term, n = 3,267) 262 (7.6%) presented with symptoms of suspected EOS. There were no cases of culture-proven EOS. Only 1.9% of the neonates were treated with antibiotics (median antibiotic treatment, 2 days) and 4.0% were evaluated. According to NSC, antibiotics would have been administered in 5.4% of infants (absolute difference between SCO and NSC, 3.51%; 95% CI, 3.14–3.71%; p <0.0001) and 5.6% of infants would have undergone “rule out sepsis” (absolute difference between SCO and NSC, 1.63%, 95% CI 1.10–2.05; p <0.0001).ConclusionSCO minimizes laboratory testing and unnecessary antibiotics in infants at risk of EOS or with mild non-progressive symptoms, without the risk of a worse neonatal outcome. The NSC recommends almost three times more antibiotics than the SCO without improving neonatal outcomes.

Improved efficiency in the management of newborns with infectious risk factors by the sepsis risk calculator and clinical observation

“… 14 Furthermore, a recent study suggests that serial clinical observation could safely reduce the use of antibiotic therapy even to one-third of that recommended by the SRC. 22 In that study only 1.9 % of infants received antibiotics for a short period of time. In the present study, if the decision to screen and treat or not had been based on clinical findings and physical examination in the first hours of life, the total number of patients treated could have been between 2 and 6 %.…”

Exposure to Prolonged Rupture of Membranes at Term Increases the Risk for Ventilatory Support in Uninfected Neonates

“…Although these findings would suggest an increased frequency of infection (perhaps related to prolonged ROM), no differences in postnatal antibiotic exposure were found and no infants had positive blood culture; among neonates with ROM > 24 hours and respiratory distress only one-third were given antibiotics. 19 Therefore, our data seem to suggest that respiratory distress requiring interventions is caused by intrinsic effects of prolonged ROM, in absence of infection.…”

“…Indeed, at multivariate analysis, our data indicate that neonatal ventilatory support is associated with a lower Apgar score and a birth weight < 2500 g, in addition to prolonged ROM and raised C-Reactive Protein. Although these findings would suggest an increased frequency of infection (perhaps related to prolonged ROM) no differences in postnatal antibiotic exposure were found and no infants had positive blood culture; among neonates with ROM > 24 hours and respiratory distress only 1/3 were given antibiotics 19 . Therefore, our data seem suggest that respiratory distress requiring interventions is caused by intrinsic effects of prolonged ROM, in absence of infection.…”

Use of the “Sepsis Risk Calculator” in Belgian Newborns: A Retrospective Cohort Study

“…29 In centers with strong antimicrobial stewardship and low antibiotic rates in newborns, use of the SRC would appear to increase antibiotic rates, suggesting that use of the SRC is not fitting for all centers. 1,27,36 However, our center shows a high rate of antibiotic therapy in newborns compared with other high-income countries and would therefore benefit from use of the SRC. 1 Limitations of this study include its retrospective nature and the lack of data on possible readmissions for EONS.…”