General University Hospital Dr. Balmis, Neonatal Unit, Alicante, Spain.
Hospital Universitario Materno-Infantil de Las Palmas, Division of Neonatology, Las Palmas de Gran Canaria, Spain.
J Pediatr (Rio J). 2024 Jan-Feb;100(1):100-107. doi: 10.1016/j.jped.2023.07.008. Epub 2023 Sep 24.
To evaluate the efficiency of the sepsis risk calculator and the serial clinical observation in the management of late preterm and term newborns with infectious risk factors.
Single-center, observational, two-phase cohort study comparing the rates of neonates born ≥35 weeks' gestation, ≥2000 g birthweight, and without major congenital anomalies, who were screened and/or received antibiotics for early-onset neonatal sepsis risk at our center during two periods, before (January/2018-June/2019) and after (July/2019-December/2020) the implementation of the sepsis risk calculator.
A total of 1796 (Period 1) and 1867 (Period 2) patients with infectious risk factors were included. During the second period, tests to rule out sepsis were reduced by 34.0 % (RR, 95 %CI): 0.66 (0.61, 0.71), blood cultures by 13.1 %: 0.87 (0.77, 0.98), hospital admissions by 13.5 %: 0.86 (0.76, 0.98) and antibiotic administration by 45.9 %: 0.54 (0.47, 0.63). Three cases of early-onset neonatal sepsis occurred in the first period and two in the second. Clinical serial evaluation would have detected all true cases.
The implementation of a sepsis risk calculator in the management of newborns ≥35 weeks GA, ≥2000 g birthweight, without major congenital anomalies, with infectious risk factors is safe and adequate to reduce laboratory tests, blood cultures, hospital admissions, and antibiotics administration. Serial clinical observation, in addition, could be instrumental to achieve or even improve this goal.
评估脓毒症风险计算器在管理有感染危险因素的晚期早产儿和足月儿中的效率。
单中心、观察性、两阶段队列研究比较了在两个时期，即脓毒症风险计算器实施前（2018 年 1 月至 2019 年 6 月）和实施后（2019 年 7 月至 2020 年 12 月），在本中心筛查和/或接受早发性新生儿败血症风险抗生素治疗的胎龄≥35 周、出生体重≥2000g、无重大先天畸形的新生儿的发生率。
共有 1796 名（第 1 期）和 1867 名（第 2 期）有感染危险因素的患儿被纳入研究。在第 2 阶段，排除败血症的检查减少了 34.0%（RR，95%CI）：0.66（0.61，0.71），血培养减少了 13.1%：0.87（0.77，0.98），住院减少了 13.5%：0.86（0.76，0.98），抗生素使用减少了 45.9%：0.54（0.47，0.63）。第 1 阶段发生了 3 例早发性新生儿败血症，第 2 阶段发生了 2 例。临床连续评估将发现所有真正的病例。
在管理胎龄≥35 周、出生体重≥2000g、无重大先天畸形、有感染危险因素的新生儿时，使用脓毒症风险计算器是安全和充分的，可以减少实验室检查、血培养、住院和抗生素的使用。此外，连续的临床观察有助于实现甚至改善这一目标。
