Recommended Citation
Lang L, Bennett C. Prophylactic antibiotics for neonates, are we causing more harm than good? Poster presented at: AWHONN National Convention; June 25, 2022; Aurora, CO.
Presentation Notes
Poster presented at: AWHONN National Convention; June 25, 2022; Aurora, CO. Published abstract can be viewed here: https://institutionalrepository.aah.org/nurs/203/
Abstract
Introduction: Early neonatal antibiotic exposure causes disruption of the intestinal Introduction microbiome which may lead to lifelong health consequences including asthma, lung disease, obesity, and inflammatory bowel disease. Standard practice for well appearing neonates born to mothers with chorioamnionitis included a blood culture, complete blood count and 4 doses of antibiotics over 36 hours. Audits of newborns in 2016 indicated that 100% of well appearing newborns had negative blood cultures at 36 hours, confirming that they did not have early onset sepsis. The antibiotics these infants received were prophylactic and unnecessary. When the American Academy of Pediatrics endorsed the use of a multivariate risk assessment neonatal sepsis calculator, we began formulating our plan for implementation.
Methods: Using a 30/60/90-day quality improvement model, the obstetrical and neonatal department implemented the use of the neonatal early onset sepsis calculator. Nurses and health care providers were educated on the use of the calculator which evaluated specific factors at birth to arrive at a sepsis risk score. The factors included maternal highest temperature during labor, Group B Strep status, antibiotic timing in relation to delivery, length of rupture of membranes, and neonatal gestational age. The calculator was used for all neonates born at >35 weeks gestation admitted to the mother baby unit beginning January 2021. Data was manually extracted for infants born to mothers with a diagnosis of chorioamnionitis. Data points collected were race, gestational age, blood culture collection and antibiotics administration rates.
Results: The number of blood cultures collected was reduced by 82% and antibiotic administration reduced by 96% following implementation of the calculator.
Discussion/Conclusion: Up to 30,000 infants are born in the United States each year to mothers with a diagnosis of chorioamnionitis. Universal implementation of the neonatal sepsis calculator among clinically well appearing neonates ≥ 35 weeks of gestation born to mother with chorioamnionitis throughout the United States would significantly reduce the number of newborns receiving antibiotics, providing an opportunity of life without chronic diseases associated with early exposure to antibiotics and saving countless healthcare dollars.
Document Type
Poster
Affiliations
Advocate Lutheran General Hospital
Advocate Children's Hospital