Fernandes Michelle, Winckworth Lucinda, Lee Lyrille, Akram Madiha, Struthers Simon
The Department of Neonatal Medicine and the Neonatal Intensive Care Unit, Princess Anne Hospital University Hospitals Southampton NHS Foundation Trust Southampton UK.
The MRC Lifecourse Epidemiology Centre and Human Development and Health Academic Unit, Faculty of Medicine University of Southampton Southampton UK.
Pediatr Investig. 2022 Aug 24;6(3):171-178. doi: 10.1002/ped4.12344. eCollection 2022 Sep.
Effective screening strategies for early-onset neonatal sepsis (EONS) have the potential to reduce high volume parenteral antibiotics (PAb) usage in neonates.
To compare management decisions for EONS, between CG149 National Institute for Health and Care Excellence (NICE) guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator (SRC) in a level 2 neonatal unit at a district general hospital (DGH).
Hospital records were reviewed for maternal and neonatal risk factors for EONS, neonatal clinical examination findings, and microbial culture results for all neonates born at ≥34 weeks' gestation between February and July 2019, who were (1) managed according to CG149-NICE guidelines or (2) received PAb within 72 h following birth at a DGH in Winchester, UK. SRC projections were obtained using its virtual risk estimator.
Sixty infants received PAb within the first 72 h of birth during the study period. Of these, 19 (31.7%) met SRC criteria for antibiotics; 20 (33.3%) met the criteria for enhanced observations and none had culture-proven sepsis. Based on SRC projections, neonates with '≥1 NICE clinical indicator and ≥1 risk factor' were most likely to have a sepsis risk score (SRS) >3. Birth below 37 weeks' gestation (risk ratio [RR] = 2.31, 95% confidence interval [CI]: 1.02-5.22) and prolonged rupture of membranes (RR = 3.14, 95% CI: 1.16-8.48) increased the risk of an SRS >3.
Screening for EONS on the SRC could potentially reduce PAb usage by 68% in term and near-term neonates in level 2 neonatal units.
有效的早发型新生儿败血症（EONS）筛查策略有可能减少新生儿高剂量肠外抗生素（PAb）的使用。
比较英国国家卫生与临床优化研究所（NICE）CG149指南与通过在一家地区综合医院（DGH）的二级新生儿病房虚拟应用凯撒医疗集团败血症风险计算器（SRC）预测的EONS管理决策。
回顾了2019年2月至7月在该医院出生的所有孕周≥34周新生儿的医院记录，包括EONS的母婴风险因素、新生儿临床检查结果和微生物培养结果，这些新生儿（1）按照CG149-NICE指南进行管理，或（2）在英国温彻斯特一家DGH出生后72小时内接受了PAb治疗。使用SRC的虚拟风险估计器获得SRC预测结果。
在研究期间，60名婴儿在出生后的头72小时内接受了PAb治疗。其中，19名（31.7%）符合SRC抗生素标准；20名（33.3%）符合加强观察标准，且无一例有培养证实的败血症。根据SRC预测，有“≥1个NICE临床指标和≥1个风险因素”的新生儿最有可能败血症风险评分（SRS）>3。孕周<37周出生（风险比[RR]=2.31，95%置信区间[CI]：1.02-5.22）和胎膜早破时间延长（RR=3.14，95%CI：1.16-8.48）增加了SRS>3的风险。
在二级新生儿病房中，使用SRC筛查EONS可能会使足月儿和近足月儿的PAb使用量减少68%。
