Neonatal Medicine, Singleton Hospital, Swansea, UK.
Neonatal Medicine, University Hospital of Wales, Cardiff, UK.
Arch Dis Child Fetal Neonatal Ed. 2020 Mar;105(2):118-122. doi: 10.1136/archdischild-2018-316777. Epub 2019 Jul 11.
To compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS).
Multicentre prospective observational projection study.
Eight maternity hospitals in Wales, UK.
All live births ≥34 weeks gestation over a 3-month period (February-April 2018).
Demographics, maternal and infant risk factors, infant's clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC.
Proportion of infants recommended for antibiotics on either tool.
Of 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction of 74%. Of the 426 infants avoiding antibiotics, SRC assigned 314 (54.6%) to normal care only. There were seven positive blood cultures-three infants were recommended antibiotics by both, three were not identified in the asymptomatic stage by either; one was a contaminant. No EONS-related readmission was reported.
The judicious adoption of SRC in UK clinical practice for screening and management of EONS could potentially reduce interventions and antibiotic usage in three out of four term or near-term infants and promote earlier discharge from hospital in >50%. We did not identify any EONS case missed by SRC when compared with NICE. These results have significant implications for healthcare resources.
比较英国国民保健制度（NICE）指南的管理建议与凯撒永久脓毒症风险计算器（SRC）对早发性新生儿脓毒症（EONS）的风险预测。
多中心前瞻性观测预测研究。
英国威尔士的 8 家妇产医院。
34 周以上足月产活产儿，持续 3 个月（2018 年 2 月至 4 月）。
收集人口统计学资料、母婴危险因素、婴儿临床状态、出生后前 72 小时内的抗生素使用情况和血培养结果。采用 NICE 推荐的方法对婴儿进行管理，并将决策与 SRC 预测的结果进行比较。
两种工具推荐使用抗生素的婴儿比例。
在 4992 名符合条件的婴儿中，3593 名（71.9%）婴儿有完整的数据。其中，576 名（16%）根据 NICE 建议使用了抗生素，而 SRC 预测有 156 名（4.3%）婴儿需要使用抗生素，相对减少了 74%。在避免使用抗生素的 426 名婴儿中，SRC 将 314 名（54.6%）婴儿分配到仅接受常规护理。有 7 份血培养阳性结果——有 3 名婴儿两种工具均建议使用抗生素，有 3 名婴儿在无症状阶段均未被任何一种工具识别，有 1 份是污染菌。未报告与 EONS 相关的再入院病例。
在英国临床实践中，明智地采用 SRC 对 EONS 进行筛查和管理，可能会使四分之三或近四分之三的足月或近足月婴儿减少干预和抗生素使用，并使超过 50%的婴儿更早出院。与 NICE 相比，我们未发现 SRC 漏诊任何 EONS 病例。这些结果对医疗资源具有重要意义。
