Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

• Main Authors: Francesco Cavigioli (Author), Francesca Viaroli (Author), Irene Daniele (Author), Michela Paroli (Author), Luigi Guglielmetti (Author), Elena Esposito (Author), Francesco Cerritelli (Author), Gianvincenzo Zuccotti (Author), Gianluca Lista (Author)
• Format: Book
• Published: MDPI AG, 2022-08-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/antibiotics11081089; 2079-6382
• Keywords: early onset sepsis; newborns; antibiotics; mortality; infection; serial clinical examination; Therapeutics. Pharmacology; RM1-950
• Source: Antibiotics, Vol 11, Iss 8, p 1089 (2022)

Current neonatal early-onset sepsis (EOS) guidelines lack consensus. Recent studies suggest three different options for EOS risk assessment among infants born ≥35 wks gestational age (GA), leading to different behaviors in the sepsis workup and antibiotic administration. A broad disparity in clinical practice is found in Neonatal Units, with a large number of non-infected newborns evaluated and treated for EOS. Broad spectrum antibiotics in early life may induce different short- and long-term adverse effects, longer hospitalization, and early mother-child separation. In this single-center prospective study, a total of 3002 neonates born in three periods between 2016 and 2020 were studied, and three different workup algorithms were compared: the first one was based on the categorical risk assessment; the second one was based on a Serial Physical Examination (SPE) strategy for infants with EOS risk factors; the third one associated an informatic tool (Neonatal EOS calculator) with a universal extension of the SPE strategy. The main objective of this study was to reduce the number of neonatal sepsis workups and the rate of antibiotic administration and favor rooming-in and mother-infant bonding without increasing the risk of sepsis and mortality. The combined strategy of universal SPE with the EOS Calculator showed a significant reduction of laboratory tests (from 33% to 6.6%; <i>p</i> < 0.01) and antibiotic treatments (from 8.5% to 1.4%; <i>p</i> < 0.01) in term and near-term newborns. EOS and mortality did not change significantly during the study period.