Mazabanda López Diego Andrés, Taboada Rubinos Carla, Hernández Ortega Andrea, Pérez Guedes Lucía Del Mar, Urquía Martí Lourdes, García-Muñoz Rodrigo Fermín
Division of Neonatology, Hospital Universitario Materno-Infantil de Las Palmas, Las Palmas de Gran Canaria, Spain.
J Perinat Med. 2022 May 11;50(8):1150-1156. doi: 10.1515/jpm-2021-0372. Print 2022 Oct 26.
The Northern California Kaiser-Permanente Neonatal Sepsis Risk Calculator (SRC) has proved to be safe and effective in reducing laboratory tests, hospital admissions, and administration of antibiotics to patients at risk of early-onset neonatal sepsis (EONS). Many studies have focused on maternal chorioamnionitis as the principal risk factor for EONS. We wanted to know if the use of the SRC could be equally efficient in the context of several other infectious risk factors (IRF), in addition to chorioamnionitis, such as intrapartum maternal fever, GBS colonization and/or prolonged rupture of membranes (PROM).
Systematic study of neonates with ≥35 weeks gestational age (GA), born in our tertiary university hospital during a period of 18 months. Patients were retrospectively assessed with the SRC and its recommendations were compared with the actual management. A bivariate analysis of perinatal interventions, and outcomes was performed.
A total of 5,885 newborns were born during the study period and 1783 mothers (31%) had at least one IRF. The incidence of culture-proven EONS was 0.5‰. The use of the SRC would have reduced laboratory evaluations (CBC and CRP) from 56.2 to 23.3%, and blood cultures, hospital admissions and antibiotic therapy from 22.9 to 15.5%, 17.8 and 7.6%, respectively. The management based on patients' symptoms would have shown a reduction to 7.5% in all the outcomes of interest.
Both, the SRC and the management based on clinical findings, are safe and efficient to reduce the number of analytical studies, hospital admissions and administration of antibiotics to neonates with IRF.
北加利福尼亚凯撒-永久新生儿败血症风险计算器（SRC）已被证明在减少对有早发性新生儿败血症（EONS）风险的患者进行实验室检查、住院治疗和抗生素使用方面是安全有效的。许多研究都将产妇绒毛膜羊膜炎作为EONS的主要风险因素。我们想了解，除绒毛膜羊膜炎外，在存在其他几种感染风险因素（IRF）的情况下，如产时产妇发热、GBS定植和/或胎膜早破（PROM），使用SRC是否同样有效。
对在我们三级大学医院出生、孕周≥35周的新生儿进行为期18个月的系统研究。对患者进行回顾性SRC评估，并将其建议与实际管理情况进行比较。对围产期干预措施和结局进行双变量分析。
研究期间共出生5885例新生儿，1783名母亲（31%）至少有一项IRF。经培养证实的EONS发病率为0.5‰。使用SRC可将实验室检查（血常规和CRP）从56.2%降至23.3%，血培养、住院治疗和抗生素治疗分别从22.9%降至15.5%、17.8%和7.6%。基于患者症状的管理可使所有相关结局降至7.5%。
SRC以及基于临床发现的管理措施，在减少对有IRF的新生儿进行分析性研究、住院治疗和抗生素使用的数量方面都是安全有效的。
