Antibiotic Treatment for Well-Appearing Infants Born at ≥35 Weeks’ Gestation to Mothers with Chorioamnionitis Before and After Implementation of Neonatal Early-Onset Sepsis Calculator

Authors

Surichhya Bajracharya, Neonatal Perinatal Medicine, Advocate Children’s Hospital, Park Ridge, ILFollow
Preetha Prazad, Neonatal Perinatal Medicine, Advocate Children’s Hospital, Park Ridge, ILFollow
Catherine Bennett, Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, ILFollow
Nahren Asado, Pathology, Advocate Lutheran General Hospital, Park Ridge, ILFollow

Publication Date

4-2-2024

Keywords

neonatal; early-onset sepsis; calculator; chorioamnionitis

Abstract

Purpose

Our quality improvement study aimed to determine whether application of a neonatal early-onset sepsis calculator (NSC) among well-appearing infants born at ≥ 35 weeks’ gestation to mothers with chorioamnionitis decreases the number of lab evaluations (LEs) and antibiotic treatments (Abxs) without missing early-onset sepsis.

Methods

We compared 2 years (January 1, 2019–January 3, 2021) of data from a historical-control group before implementation of the NSC to 1 year (January 4, 2021–December 31, 2021) of data from a calculator group after implementation of the NSC to evaluate whether LE and Abx decreased following implementation of the NSC on January 4, 2021. A P-value of < 0.05 was considered statistically significant for the chi-squared test, Fisher’s exact test, Student’s t-test, and Mann-Whitney U test used for the analyses.

Results

In the historical-control group, 94% of infants received LE and Abx. Retrospective application of the NSC in the historical-control group decreased LE from 94% to 21% and Abx from 94% to 13%. In the calculator group, 14% and 5% of infants received LE and Abx, respectively, and none of the blood culture was positive. Median time from birth to antibiotic initiation was significantly longer (14.5 vs 3.8 hours; P = 0.0037) with no increase in median length of stay (2.3 vs 2.4 days; P = 0.02) after NSC implementation. No significant difference in neonatal intensive care unit admission was identified between groups (4% vs 1%; P = 0.15).

Conclusions

There was a significant decrease in LE and Abx among well-appearing infants born at ≥ 35 weeks’ gestation to mothers with chorioamnionitis after implementation of the NSC without missing early-onset sepsis. There was no increase in neonatal intensive care unit admission or length of hospital stay in infants who received antibiotics later after they appeared equivocal or clinically ill in the calculator group. Larger prospective studies that include follow ups are needed to confirm that early-onset sepsis is not missed. (J Patient Cent Res Rev. 2024;11:29-35.)

Recommended Citation

Bajracharya S, Prazad P, Bennett C, et al. Antibiotic treatment for well-appearing infants born at ≥35 weeks’ gestation to mothers with chorioamnionitis before and after implementation of neonatal early-onset sepsis calculator. J Patient Cent Res Rev. 2024;11:29-35. doi: 10.17294/2330-0698.2005