Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2022 Nov;58(11):1958-1963. doi: 10.1111/jpc.16128. Epub 2022 Jul 23.
The sepsis risk calculator (SRC) has been shown to reduce empirical antibiotic usage in neonates at risk of early-onset sepsis without increasing adverse clinical outcomes. However, its use for categorising and improving identification of at-risk neonates exposed to chorioamnionitis in the local population has not been reported. This study compares the management guided by the SRC to our unit's clinical practice of administering empirical antibiotics to all term neonates (born ≥37 weeks gestation), symptomatic and asymptomatic, who were exposed to chorioamnionitis, and evaluates the performance of the SRC in managing asymptomatic term neonates exposed to chorioamnionitis.
This single-centre retrospective study identified 178 eligible term neonates exposed to chorioamnionitis over a 17-month study period. Relevant demographic and clinical information on the mother-infant dyad was collected. The SRC was executed retrospectively in the study cohort. Descriptive statistics were used for reporting the findings.
The mean gestational age was 39 (standard deviation, SD 1) weeks, and the mean birth weight was 3472 (SD 482) g. Of the 178 neonates, 136 (76%) were asymptomatic and received empirical antibiotic therapy for 2 days (mean). Based on management recommendations from the SRC, empirical antibiotic therapy could have been avoided in 98% of asymptomatic neonates; 88% could have been managed by observation alone, avoiding mother-infant separation. No neonate died or had a positive blood culture result.
The SRC could reduce antibiotic exposure in asymptomatic neonates exposed to chorioamnionitis. It could assist clinicians to categorise risk in neonates exposed to chorioamnionitis.
已有研究表明，在有早发性败血症风险的新生儿中，使用败血症风险计算器（SRC）可以减少经验性抗生素的使用，而不会增加不良临床结局。然而，在本地区人群中，SRC 用于分类和改善暴露于绒毛膜羊膜炎的高危新生儿的识别尚未见报道。本研究比较了使用 SRC 指导的管理与我们单位对所有足月（胎龄≥37 周）新生儿（出生≥37 周）的临床实践，即对所有有症状和无症状暴露于绒毛膜羊膜炎的新生儿给予经验性抗生素治疗，并评估了 SRC 在管理无症状暴露于绒毛膜羊膜炎的足月新生儿方面的表现。
本单中心回顾性研究在 17 个月的研究期间，共确定了 178 例有绒毛膜羊膜炎暴露的足月新生儿。收集了母婴对相关人口统计学和临床信息。在研究队列中，对 SRC 进行了回顾性执行。使用描述性统计方法报告研究结果。
平均胎龄为 39 周（标准差 1 周），平均出生体重为 3472 克（标准差 482 克）。在 178 例新生儿中，136 例（76%）无症状，接受了 2 天（平均）的经验性抗生素治疗。根据 SRC 的管理建议，98%的无症状新生儿可以避免使用经验性抗生素治疗；88%可以通过单独观察来管理，避免母婴分离。没有新生儿死亡或血培养阳性。
SRC 可减少暴露于绒毛膜羊膜炎的无症状新生儿的抗生素暴露。它可以帮助临床医生对暴露于绒毛膜羊膜炎的新生儿进行风险分类。
