RT Journal Article
SR Electronic
T1 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
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 581
OP 586
DO 10.1136/archdischild-2019-317165
VO 105
IS 6
A1 Rachel Morris
A1 Steve Jones
A1 Sujoy Banerjee
A1 Andrew Collinson
A1 Hannah Hagan
A1 Hannah Walsh
A1 Graham Thornton
A1 Ian Barnard
A1 Chris Warren
A1 Jennifer Reid
A1 Alison Busfield
A1 Jean Matthes
YR 2020
UL http://fn.bmj.com/content/105/6/581.abstract
AB 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.