Achten Niek B, Dorigo-Zetsma J Wendelien, van Rossum Annemarie M C, Oostenbrink Rianne, Plötz Frans B
Department of Paediatrics, Tergooi Hospitals, Blaricum, The Netherlands.
Department of Paediatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Clin Exp Pediatr. 2020 Oct;63(10):406-410. doi: 10.3345/cep.2020.00094. Epub 2020 Apr 16.
The early-onset sepsis (EOS) calculator was developed and validated in a setting with routine-based group B Streptococcus (GBS) screening.
The study aimed to evaluate the extent of influence exerted by risk-based GBS screening on management recommendations by the EOS calculator.
All newborns with a gestational age greater than 35 weeks were screened for EOS risk factors in a Dutch regional teaching hospital using a risk-based GBS screening strategy. We calculated the EOS risk at birth and stratified the infants into the following 3 risk levels with corresponding management recommendations: low, <0.65; intermediate, 0.65-1.54; and high, >1.54 per 1000 live newborns. Thereafter, we recalculated the EOS risk and recommendation for the newborn infants without available maternal GBS screening results at birth.
In one year, 1,877 eligible births occurred; of them, 206 infants were included. Maternal GBS status was available for 28 of 206 infants (14%) at birth, while a definitive GBS status was later available for 162 of 206 infants (79%). Median EOS risk was slightly lower after definitive GBS status was determined (0.41 vs. 0.46 per 1,000 live births, P=0.004). In 199 of 206 newborn infants (97%), the EOS calculator recommendation remained unchanged after the GBS results unavailable at birth were updated to definitive GBS status. Use of GBS status at birth versus definitive GBS status did not result in the withholding of antibiotic treatment of the newborn infants included in this study.
Risk-based GBS screening is compatible with EOS calculator recommendations. Larger studies are needed to develop the best strategy for combining GBS screening and EOS calculator recommendations.
早发型败血症（EOS）计算器是在基于常规的B族链球菌（GBS）筛查背景下开发并验证的。
本研究旨在评估基于风险的GBS筛查对EOS计算器管理建议的影响程度。
在一家荷兰地区教学医院，采用基于风险的GBS筛查策略，对所有孕周大于35周的新生儿进行EOS风险因素筛查。我们计算出生时的EOS风险，并将婴儿分为以下3个风险等级及相应的管理建议：低风险，<0.65；中等风险，0.65 - 1.54；高风险，>1.54（每1000例活产新生儿）。此后，我们重新计算了出生时无母亲GBS筛查结果的新生儿的EOS风险及建议。
一年内发生了1877例符合条件的分娩；其中，206例婴儿被纳入研究。206例婴儿中有28例（14%）出生时可获得母亲GBS状态，而206例婴儿中有162例（79%）之后获得了明确的GBS状态。确定明确的GBS状态后，EOS风险中位数略低（每1000例活产儿中为0.41 vs. 0.46，P = 0.004）。在206例新生儿中有199例（97%），出生时未获得的GBS结果更新为明确的GBS状态后，EOS计算器的建议保持不变。使用出生时的GBS状态与明确的GBS状态，并未导致本研究中纳入的新生儿被 withholding抗生素治疗。
基于风险的GBS筛查与EOS计算器的建议兼容。需要开展更大规模的研究来制定结合GBS筛查和EOS计算器建议的最佳策略。
