Bajracharya Surichhya, Prazad Preetha, Bennett Catherine, Asado Nahren
Neonatal Perinatal Medicine, Advocate Children's Hospital, Park Ridge, IL.
Obstetrics and Gynecology, Advocate Lutheran General Hospital, Park Ridge, IL.
J Patient Cent Res Rev. 2024 Apr 2;11(1):29-35. doi: 10.17294/2330-0698.2005. eCollection 2024 Spring.
Our quality improvement study aimed to determine whether application of a neonatal early-onset sepsis calculator (NSC) among well-appearing infants born at ≥35 weeks' gestation to mothers with chorioamnionitis decreases the number of lab evaluations (LEs) and antibiotic treatments (Abxs) without missing early-onset sepsis.
We compared 2 years (January 1, 2019-January 3, 2021) of data from a historical-control group before implementation of the NSC to 1 year (January 4, 2021-December 31, 2021) of data from a calculator group after implementation of the NSC to evaluate whether LE and Abx decreased following implementation of the NSC on January 4, 2021. A P-value of <0.05 was considered statistically significant for the chi-squared test, Fisher's exact test, Student's -test, and Mann-Whitney test used for the analyses.
In the historical-control group, 94% of infants received LE and Abx. Retrospective application of the NSC in the historical-control group decreased LE from 94% to 21% and Abx from 94% to 13%. In the calculator group, 14% and 5% of infants received LE and Abx, respectively, and none of the blood culture was positive. Median time from birth to antibiotic initiation was significantly longer (14.5 vs 3.8 hours; P=0.0037) with no increase in median length of stay (2.3 vs 2.4 days; P=0.02) after NSC implementation. No significant difference in neonatal intensive care unit admission was identified between groups (4% vs 1%; P=0.15).
There was a significant decrease in LE and Abx among well-appearing infants born at ≥35 weeks' gestation to mothers with chorioamnionitis after implementation of the NSC without missing early-onset sepsis. There was no increase in neonatal intensive care unit admission or length of hospital stay in infants who received antibiotics later after they appeared equivocal or clinically ill in the calculator group. Larger prospective studies that include follow ups are needed to confirm that early-onset sepsis is not missed.
我们的质量改进研究旨在确定，对于妊娠≥35周、母亲患有绒毛膜羊膜炎且外观良好的新生儿，应用新生儿早发型败血症计算器（NSC）是否能在不遗漏早发型败血症的情况下，减少实验室检查（LE）的次数和抗生素治疗（Abx）的使用。
我们将NSC实施前2年（2019年1月1日至2021年1月3日）历史对照组的数据与NSC实施后1年（2021年1月4日至2021年12月31日）计算器组的数据进行比较，以评估2021年1月4日实施NSC后LE和Abx是否减少。用于分析的卡方检验、Fisher精确检验、Student's t检验和Mann-Whitney检验中，P值<0.05被认为具有统计学意义。
在历史对照组中，94%的婴儿接受了LE和Abx。在历史对照组中对NSC进行回顾性应用后，LE从94%降至21%，Abx从94%降至13%。在计算器组中，分别有14%和5%的婴儿接受了LE和Abx，且血培养均为阴性。实施NSC后，从出生到开始使用抗生素的中位时间显著延长（14.5小时对3.8小时；P=0.0037），但中位住院时间没有增加（2.3天对2.4天；P=0.02）。两组之间在新生儿重症监护病房入院率方面没有显著差异（4%对1%；P=0.15）。
在实施NSC后，对于妊娠≥35周、母亲患有绒毛膜羊膜炎且外观良好的新生儿，LE和Abx显著减少，且未遗漏早发型败血症。在计算器组中，那些最初情况不明确或临床患病后较晚才接受抗生素治疗的婴儿，其新生儿重症监护病房入院率或住院时间没有增加。需要开展包括随访的更大规模前瞻性研究，以确认未遗漏早发型败血症。
