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Implementation of an adapted Sepsis Risk Calculator algorithm to reduce antibiotic usage in the management of early onset neonatal sepsis: a multicentre initiative in Wales, UK
  1. Nitin Goel1,
  2. Stephanie Cannell2,
  3. Gemma Davies2,
  4. Murali Sridhar Natti3,
  5. Vickness Kirupaalar4,
  6. Artur Abelian5,
  7. Shakir Saeed6,
  8. Rhian Smith7,
  9. Ravi Manikonda8,
  10. Prem Kumar Pitchaikani9,
  11. Dawn Davies10,
  12. Rachel May Morris1,
  13. Lynsey Edwards1,
  14. Roopashree Govindaraju3,
  15. Kate Creese4,
  16. Jane Jones5,
  17. Jalil Choudhary6,
  18. Sarah Rowley1,
  19. Chidambaram Sethuraman3,
  20. Helen Muxworthy11,
  21. Felicity Curtis11,
  22. Patricia Donnelly4,
  23. Manohar Joishy6,
  24. Ian Barnard7,
  25. Celyn Kenny1,
  26. Rajarshi Pal9,
  27. Karen Jones9,
  28. Sujoy Banerjee2
  1. 1 Department of Neonatal Medicine, University Hospital of Wales, Cardiff, UK
  2. 2 Department of Neonatal Medicine, Singleton Hospital, Swansea, UK
  3. 3 Department of Neonatal Medicine, Royal Gwent Hospital, Newport, UK
  4. 4 Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
  5. 5 Department of Paediatrics, Wrexham Maelor Hospital, Wrexham, UK
  6. 6 Department of Paediatrics, Ysbyty Gwynedd, Bangor, Gwynedd, UK
  7. 7 Department of Neonatal Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
  8. 8 Department of Paediatrics, Nevill Hall Hospital, Abergavenny, UK
  9. 9 Department of Paediatrics, Glangwili General Hospital, Carmarthen, Carmarthenshire, UK
  10. 10 Department of Paediatrics, Bronglais General Hospital, Aberystwyth, Ceredigion, UK
  11. 11 Department of Women's Health, Singleton Hospital, Swansea, UK
  1. Correspondence to Dr Sujoy Banerjee, Department of Neonatal Medicine, Singleton Hospital, Swansea, SA2 8QA, UK; sujoy.banerjee{at}


Objective Assess the impact of introducing a consensus guideline incorporating an adapted Sepsis Risk Calculator (SRC) algorithm, in the management of early onset neonatal sepsis (EONS), on antibiotic usage and patient safety.

Design Multicentre prospective study

Setting Ten perinatal hospitals in Wales, UK.

Patients All live births ≥34 weeks’ gestation over a 12-month period (April 2019–March 2020) compared with infants in the preceding 15-month period (January 2018–March 2019) as a baseline.

Methods The consensus guideline was introduced in clinical practice on 1 April 2019. It incorporated a modified SRC algorithm, enhanced in-hospital surveillance, ongoing quality assurance, standardised staff training and parent education. The main outcome measure was antibiotic usage/1000 live births, balancing this with analysis of harm from delayed diagnosis and treatment, disease severity and readmissions from true sepsis. Outcome measures were analysed using statistical process control charts.

Main outcome measures Proportion of antibiotic use in infants ≥34 weeks’ gestation.

Results 4304 (14.3%) of the 30 105 live-born infants received antibiotics in the baseline period compared with 1917 (7.7%) of 24 749 infants in the intervention period (45.5% mean reduction). All 19 infants with culture-positive sepsis in the postimplementation phase were identified and treated appropriately. There were no increases in sepsis-related neonatal unit admissions, disease morbidity and late readmissions.

Conclusions This multicentre study provides evidence that a judicious adaptation of the SRC incorporating enhanced surveillance can be safely introduced in the National Health Service and is effective in reducing antibiotic use for EONS without increasing morbidity and mortality.

  • neonatology
  • health services research

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors SB and NG conceived this project, authored the guideline, devised training package and data collection tools, analysed data and produced the first draft of the manuscript for publication. SC, GD, MN, VK, AA, SS, RS, RM, PKP, DD, RM, LE, RG, KC, JJ, JC, SR, CS, HM, FC, PC, MJ, IB, CK, RP and KJ contributed to the development of guideline, information leaflets, led local training and audit, and collected and submitted data for analysis. All authors critically appraised and approved the final submitted version of the manuscript.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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