Fischer Ashley, Mowrer Michael Colin, Shallat Shelly, Walker Lucas, Shallat Jaclyn
Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois;
Division of Neonatology, Children's Hospital of Illinois, Peoria, Illinois.
Hosp Pediatr. 2020 Oct;10(10):877-883. doi: 10.1542/hpeds.2020-0153.
Evaluation of well-appearing neonates for early-onset sepsis (EOS) remains controversial. Multiple risk stratification approaches are currently used for the evaluation of EOS. Our aim was to quantify and compare frequency of laboratory evaluation and empirical antibiotics between published and local EOS approaches.
This retrospective cohort study included 8240 infants born ≥35 + 0/7 weeks' gestation at an institution from October 1, 2014, to March 1, 2018. Excluded from analysis were 156 patients who exhibited either major congenital anomalies or required antibiotics for surgical issues. A total of 1680 patient charts with risk factors for EOS were reviewed for further demographic data, clinical presentation, laboratory results, and probable recommendations from 4 EOS risk assessment approaches.
Laboratory evaluation recommendation was 7.1% for Centers for Disease Control and Prevention 2010 guidelines and local 2016 EOS algorithm, 6% for local 2019 EOS algorithm, and 5.9% for Kaiser Permanente neonatal EOS calculator (neonatal EOS calculator). Antibiotic recommendation was 6% for 2010 Centers for Disease Control and Prevention guidelines, 4.3% for neonatal EOS calculator, and 3.3% for local 2016 and 2019 EOS algorithms.
Of the 4 approaches reviewed, the local 2019 EOS algorithm and the neonatal EOS calculator were similar in recommending the lowest frequency of laboratory evaluation and the local 2016 and 2019 EOS algorithms had the lowest recommended antibiotic usage in this population.
对表现良好的新生儿进行早发性败血症（EOS）评估仍存在争议。目前有多种风险分层方法用于EOS评估。我们的目的是量化并比较已发表的和本地的EOS评估方法在实验室检查和经验性抗生素使用频率方面的差异。
这项回顾性队列研究纳入了2014年10月1日至2018年3月1日在某机构出生且孕周≥35 + 0/7周的8240例婴儿。分析中排除了156例患有重大先天性异常或因手术问题需要使用抗生素的患者。共审查了1680份具有EOS风险因素的患者病历，以获取进一步的人口统计学数据、临床表现、实验室检查结果以及4种EOS风险评估方法可能给出的建议。
疾病控制与预防中心2010年指南和本地2016年EOS算法的实验室检查建议率为7.1%，本地2019年EOS算法为6%，凯撒医疗新生儿EOS计算器（新生儿EOS计算器）为5.9%。2010年疾病控制与预防中心指南的抗生素使用建议率为6%，新生儿EOS计算器为4.3%，本地2016年和2019年EOS算法为3.3%。
在所审查的4种方法中，本地2019年EOS算法和新生儿EOS计算器在推荐最低实验室检查频率方面相似，且本地2016年和2019年EOS算法在该人群中的抗生素使用建议率最低。
