Berardi Alberto, Zinani Isotta, Bedetti Luca, Vaccina Eleonora, Toschi Alessandra, Toni Greta, Lecis Marco, Leone Federica, Monari Francesca, Cozzolino Michela, Zini Tommaso, Boncompagni Alessandra, Iughetti Lorenzo, Miselli Francesca, Lugli Licia
Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Pediatric Post-Graduate School, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
Front Pediatr. 2022 Jul 22;10:882416. doi: 10.3389/fped.2022.882416. eCollection 2022.
To compare two strategies [the neonatal sepsis risk calculator (NSC) and the updated serial clinical observation approach (SCO)] for the management of asymptomatic neonates at risk of early-onset sepsis (EOS) and neonates with mild non-progressive symptoms in the first hours of life.
This was a single-center, retrospective cohort study conducted over 15 months (01/01/2019-31/03/2020). All live births at ≥34 weeks of gestation were included. Infants were managed using SCO and decisions were compared with those retrospectively projected by the NSC. The proportion of infants recommended for antibiotics or laboratory testing was compared in both strategies. McNemar's non-parametric test was used to assess significant differences in matched proportions.
Among the 3,445 neonates (late-preterm, = 178; full-term, = 3,267) 262 (7.6%) presented with symptoms of suspected EOS. There were no cases of culture-proven EOS. Only 1.9% of the neonates were treated with antibiotics (median antibiotic treatment, 2 days) and 4.0% were evaluated. According to NSC, antibiotics would have been administered in 5.4% of infants (absolute difference between SCO and NSC, 3.51%; 95% CI, 3.14-3.71%; <0.0001) and 5.6% of infants would have undergone "rule out sepsis" (absolute difference between SCO and NSC, 1.63%, 95% CI 1.10-2.05; <0.0001).
SCO minimizes laboratory testing and unnecessary antibiotics in infants at risk of EOS or with mild non-progressive symptoms, without the risk of a worse neonatal outcome. The NSC recommends almost three times more antibiotics than the SCO without improving neonatal outcomes.
比较两种策略[新生儿败血症风险计算器（NSC）和更新的系列临床观察方法（SCO）]用于管理有早发性败血症（EOS）风险的无症状新生儿以及出生后最初几小时内有轻度非进行性症状的新生儿。
这是一项在15个月（2019年1月1日至2020年3月31日）期间进行的单中心回顾性队列研究。纳入所有妊娠≥34周的活产儿。婴儿采用SCO进行管理，并将决策与NSC回顾性预测的决策进行比较。比较两种策略中建议使用抗生素或进行实验室检查的婴儿比例。采用McNemar非参数检验评估匹配比例的显著差异。
在3445例新生儿（晚期早产儿，n = 178；足月儿，n = 3267）中，262例（7.6%）出现疑似EOS症状。没有经培养证实的EOS病例。仅1.9%的新生儿接受了抗生素治疗（抗生素治疗中位数为2天），4.0%的新生儿接受了评估。根据NSC，5.4%的婴儿本应接受抗生素治疗（SCO和NSC之间的绝对差异为3.51%；95%CI，3.14 - 3.71%；P<0.0001），5.6%的婴儿本应进行“排除败血症”检查（SCO和NSC之间的绝对差异为1.63%，95%CI 1.10 - 2.05；P<0.0001）。
SCO可将有EOS风险或有轻度非进行性症状的婴儿的实验室检查和不必要的抗生素使用降至最低，且不会增加新生儿不良结局的风险。NSC推荐使用的抗生素几乎是SCO的三倍，却并未改善新生儿结局。
