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Multivariate risk and clinical signs evaluations for early-onset sepsis on late preterm and term newborns and their economic impact

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Abstract

There is an increasing evidence that strict evaluation of clinical signs is effective in detecting newborns at risk of early-onset sepsis (EOS) that require antibiotic therapy. In a retrospective case control design, we compared EOS antibiotic indication by clinical signs surveillance with multivariate risk analysis (EOSCalc), and estimate their costs. Newborns ≥ 34 weeks who received EOS antibiotics from June 2014 to December 2016 were studied. Were considered symptomatic those with three clinical signs within first 24 h or two signs and one risk factor present. Cost estimative was done using bottom-up hospital’s perspective. Eight thousand three hundred twenty-one were born, 384 were included. Two hundred nineteen (57%) would receive antibiotics by EOSCalc and 64 (16.7%) by clinical signs (p < 0.001). All patients with blood cultures were detected and false-negatives were absent. Total cost was US$ 574,121, estimate US$ 415,576 by EOSCalc, and US$ 314,353 by clinical signs (p < 0.001).

Conclusions: The use of EOSCalc and clinical signs surveillance seem to be safe and accurate methods in EOS management. Additionally, the two approaches have shown an economic advantage when compared with the hospital’s current practice.

What is Known:

• EOSCalc is a useful method for screening of EOS in late preterm and term infants.

• Presence of clinical signs and/or maternal risk factors are present newborns with EOS.

What is New:

• Rigorous observation of clinical signs is a more accurate method than EOSCalc to screen for EOS in late preterm and term newborns.

• Rigorous observation of clinical signs is more economic than EOSCalc in managing EOS in late preterm and term neonates.

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Abbreviations

EOS:

Early-onset sepsis

EOSCalc:

Early-onset sepsis calculator

GBS:

Streptococcus agalactiae

NICU:

Neonatal intensive care unit

REDCap:

Research electronic data capture

TORCH:

Syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes, acquired immunodeficiency syndrome

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Newborn Section, Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre, Rua Silva Jardim 1155#701, Porto Alegre, RS, 90450-071, Brazil

    Bianca C. Benincasa, Rita C. Silveira & Renato S. Procianoy

  2. Post-Graduation Program in Health’s Education, Universidade Federal do Rio Grande do Sul and Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

    Rosane Paixão Schlatter

  3. Department of Economics Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Giacomo Balbinotto Neto

Authors
  1. Bianca C. Benincasa
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  2. Rita C. Silveira
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  3. Rosane Paixão Schlatter
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  4. Giacomo Balbinotto Neto
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  5. Renato S. Procianoy
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Contributions

BCB wrote the draft, collected the data, were involved with statistical anlysis, and wrote and approved the definitive manuscript.

RCS wrote the draft, collected the data, were involved with statistical anlysis, and wrote and approved the definitive manuscript.

RSP wrote the draft, collected the data, were involved with statistical anlysis, and wrote and approved the definitive manuscript.

RPS wrote the draft, were involved with the economic analysis, and approved the definitive manuscript.

GBN wrote the draft, were involved with the economic analysis, and approved the definitive manuscript.

Corresponding author

Correspondence to Renato S. Procianoy.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the hospital’s Ethics in Research Review Board. This study does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Communicated by Daniele De Luca

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Benincasa, B.C., Silveira, R.C., Schlatter, R.P. et al. Multivariate risk and clinical signs evaluations for early-onset sepsis on late preterm and term newborns and their economic impact. Eur J Pediatr 179, 1859–1865 (2020). https://doi.org/10.1007/s00431-020-03727-z

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  • DOI: https://doi.org/10.1007/s00431-020-03727-z

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