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Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with NICE guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis
  1. Rachel Morris1,
  2. Steve Jones2,
  3. Sujoy Banerjee1,
  4. Andrew Collinson3,
  5. Hannah Hagan4,
  6. Hannah Walsh3,
  7. Graham Thornton2,
  8. Ian Barnard5,
  9. Chris Warren3,
  10. Jennifer Reid4,
  11. Alison Busfield4,
  12. Jean Matthes1
  1. 1 Neonatal Intensive Care, Singleton Hospital, Swansea, Wales, UK
  2. 2 Paediatrics, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
  3. 3 Paediatrics, Royal Cornwall Hospitals NHS Trust, Truro, UK
  4. 4 Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
  5. 5 Neonatal Medicine, Glan Clwyd Hospital, Rhyl, Wales, UK
  1. Correspondence to Dr Rachel Morris, Neonatal Intensive Care, Singleton Hospital, Swansea, Wales CF14 4XW, UK; rmmorris19{at}


Objective To compare the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with National Institute for Health and Care Excellence (NICE) guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis (EOS).

Design Retrospective multicentre study.

Setting Five maternity services in South West of England and Wales.

Patients 70 infants with EOS (<72 hours) confirmed on blood or cerebrospinal fluid culture.

Methods Retrospective virtual application of NICE and SRC through review of maternal and neonatal notes.

Main outcome measure The number of infants recommended antibiotics by 4 hours of birth.

Results The incidence of EOS ≥34 weeks was 0.5/1000 live births. Within 4 hours of birth, antibiotics were recommended for 39 infants (55.7%) with NICE, compared with 27 (38.6%) with SRC. The 12 infants advised early treatment by NICE but not SRC remained well, only one showing transient mild symptoms after 4 hours. Another four babies received antibiotics by 4 hours outside NICE and SRC guidance. The remaining 27 infants (38.6%) received antibiotics when symptomatic after 4 hours. Only one infant who was unwell from birth, died. Eighty-one per cent of all EOS infants were treated for clinical reasons rather than for risk factors alone.

Conclusion While both tools were poor in identifying EOS within 4 hours, NICE was superior to SRC in identifying asymptomatic cases. Currently, four out of five EOS have symptoms at first identification, the majority of whom present within 24 hours of birth. Antibiotic stewardship programmes using SRC should include enhanced observation for infants currently treated within NICE guidance.

  • sepsis risk calculator
  • neonatal
  • early onset neonatal sepsis
  • NICE Guideline CG149

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  • Contributors Study design and planning, application for whether ethics approval was necessary: JM, SJ. Data collection (maternal and neonatal data): JM, RM, SJ, GT, CW, AC, HW, HH, JR, IB, AB. Statistical analysis and interpretation: JM, SB, RM. Composition of manuscript: JM, RM, SB, SJ. Final manuscript was reviewed by all authors. JM is the overall guarantor for the content of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Individual participant data that underlie the results reported in this article, after deidentification, are available immediately following publication to researchers who provide a methodologically sound proposal. Proposals should be directed to the corresponding author RM at