Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston (Drs Romano-Clarke, Merrit, Ziady, and Nelson and Ms Morris); Harvard Medical School, Boston, Massachusetts (Drs Romano-Clarke, Merrit, Ziady, and Nelson); and Division of Obstetrics, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston (Mss Durham and Johnson).
Adv Neonatal Care. 2022 Aug 1;22(4):309-316. doi: 10.1097/ANC.0000000000000932. Epub 2021 Sep 28.
A maternal diagnosis of chorioamnionitis, based on maternal peripartum fever of 100.4°F alone, is commonly used as an indication for blood work and antibiotic treatment in newborns. New strategies such as the Kaiser Permanente early-onset sepsis (EOS) calculator have proven effective in identifying high-risk newborns and reducing unnecessary antibiotic administration.
Retrospective data from October 2017 to September 2018 from 297 well-appearing newborns ≥35 weeks' gestational age (GA) with maternal chorioamnionitis showed that 93.6% had blood work and 90.2% were treated with antibiotics. This was despite no culture-positive cases of sepsis. Our aim was to reduce by 50% blood work evaluation and antibiotic treatment within a 6-month period.
Using plan-do-study-act (PDSA) cycles, we adopted the Kaiser Permanente EOS calculator. We collected longitudinal data to track the outcomes after its implementation.
In 423 newborns with maternal chorioamnionitis triaged with the EOS calculator from October 2018 to July 2020, the rates of blood culture and antibiotic treatment decreased from 93.6% to 26.7% and 90.2% to 12.3% (P < .0001). In the larger population of 6426 newborns ≥35 weeks' GA, the rate of blood culture and antibiotic treatment decreased from 12.8% to 5.8% and 9.9% to 2.5% (P < .0001).
The EOS calculator substantially and safely decreases blood work and antibiotic administration in asymptomatic newborns with maternal chorioamnionitis.
Our findings provide further evidence for the effectiveness and safety of the EOS calculator.Video abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
临床上，产妇围产期发热至 100.4°F 即被诊断为绒毛膜羊膜炎，此时通常会对新生儿进行血液检查并给予抗生素治疗。凯泽永久早期脓毒症（EOS）计算器等新策略已被证明可有效识别高危新生儿并减少不必要的抗生素使用。
2017 年 10 月至 2018 年 9 月，对 297 例胎龄（GA）≥35 周且母亲患有绒毛膜羊膜炎的外观良好的新生儿进行回顾性数据分析，发现 93.6%的新生儿进行了血液检查，90.2%的新生儿接受了抗生素治疗。尽管没有培养出阳性脓毒症病例。我们的目标是在 6 个月内将血液检查评估和抗生素治疗减少 50%。
我们使用计划-执行-研究-行动（PDSA）循环法，采用了凯泽永久 EOS 计算器。我们收集了纵向数据以跟踪其实施后的结果。
2018 年 10 月至 2020 年 7 月，在使用 EOS 计算器对患有绒毛膜羊膜炎的 423 例新生儿进行分类的过程中，血培养和抗生素治疗的比例从 93.6%降至 26.7%，90.2%降至 12.3%（P<0.0001）。在更大的胎龄≥35 周的 6426 例新生儿中，血培养和抗生素治疗的比例从 12.8%降至 5.8%，9.9%降至 2.5%（P<0.0001）。
EOS 计算器可显著且安全地减少患有绒毛膜羊膜炎的无症状新生儿的血液检查和抗生素使用。
我们的发现为 EOS 计算器的有效性和安全性提供了进一步的证据。
