Bridges Margie, Pesek Elizabeth, McRae Michele, Chabra Shilpi
J Obstet Gynecol Neonatal Nurs. 2019 May;48(3):372-382. doi: 10.1016/j.jogn.2019.01.009. Epub 2019 Apr 8.
To evaluate the effects of use of the Kaiser Neonatal Early-Onset Sepsis Calculator (NEOSC) on NICU admissions, laboratory testing, antibiotic exposure, and exclusive breastfeeding (EBF) rates in full-term neonates exposed to chorioamnionitis.
Quality improvement project with review of retrospective data.
SETTING/LOCAL PROBLEM: In this single-site, community hospital with approximately 4,000 births per year, all neonates exposed to chorioamnionitis required NICU admission, laboratory evaluation, and empiric antibiotics.
Term neonates born to mothers diagnosed with chorioamnionitis identified through the International Classification of Diseases, Tenth Revision codes based on the discharge diagnosis.
INTERVENTION/MEASUREMENTS: The baseline retrospective analysis included calculation of sepsis risk with the Kaiser NEOSC through a chart review of neonates exposed to chorioamnionitis from January 1, 2015, to December 31, 2016. We compared the risk for sepsis with actual laboratory testing and antibiotic use and examined EBF before implementation of the use of the NEOSC. Implementation began January 2017; postintervention data were examined at 6 months and 1 year. All cases of neonates exposed to chorioamnionitis after the intervention were reviewed for use of the NEOSC, NICU admission/readmission for sepsis, laboratory testing, use of antibiotics, and EBF.
In the 12 months after NEOSC use was implemented, NICU admissions, laboratory testing, and antibiotic use decreased. Among all neonates exposed to chorioamnionitis after implementation (N = 74), 68 (93%) were not admitted to the NICU, and only 8 (11%) required laboratory evaluation. Rates of EBF in neonates exposed to chorioamnionitis increased from less than 10% to greater than 50% after implementation. The length of the NICU stay for neonates exposed to chorioamnionitis decreased from an average of 138 to 12 days with no negative consequences.
Most neonates exposed to chorioamnionitis appeared well and did not require NICU admission, laboratory testing, or antibiotic therapy. Rates of EBF improved after use of NEOSC was implemented. The practice change helped prevent adverse consequences, such as painful interventions and separation of the mother and neonate. No neonates were readmitted for sepsis.
评估使用凯泽新生儿早发型败血症计算器（NEOSC）对患有绒毛膜羊膜炎的足月儿入住新生儿重症监护病房（NICU）、实验室检查、抗生素使用及纯母乳喂养（EBF）率的影响。
回顾性数据审查的质量改进项目。
背景/当地问题：在这家每年约有4000例分娩的单中心社区医院，所有患有绒毛膜羊膜炎的新生儿均需入住NICU、进行实验室评估并接受经验性抗生素治疗。
通过基于出院诊断的国际疾病分类第十版编码确定的、母亲被诊断为绒毛膜羊膜炎的足月儿。
干预/测量：基线回顾性分析包括通过对2015年1月1日至2016年12月31日期间患有绒毛膜羊膜炎的新生儿进行病历审查，使用凯泽NEOSC计算败血症风险。我们将败血症风险与实际实验室检查及抗生素使用情况进行比较，并在实施NEOSC之前检查EBF情况。2017年1月开始实施；在6个月和1年时检查干预后的数据。对干预后所有患有绒毛膜羊膜炎的新生儿病例进行审查，以了解NEOSC的使用情况、因败血症入住/再次入住NICU、实验室检查、抗生素使用及EBF情况。
在实施NEOSC使用后的12个月内，NICU入住率、实验室检查及抗生素使用均有所下降。在实施后所有患有绒毛膜羊膜炎的新生儿中（N = 74），68例（93%）未入住NICU，只有8例（11%）需要进行实验室评估。实施后，患有绒毛膜羊膜炎的新生儿的EBF率从不到10%提高到了50%以上。患有绒毛膜羊膜炎的新生儿在NICU的住院时间从平均138天降至12天，且没有不良后果。
大多数患有绒毛膜羊膜炎的新生儿看起来情况良好，不需要入住NICU、进行实验室检查或接受抗生素治疗。实施NEOSC使用后，EBF率有所提高。这种实践改变有助于预防不良后果，如痛苦的干预措施以及母婴分离。没有新生儿因败血症再次入院。
