Brief ReportsSustainability of a Clinical Examination-Based Approach for Ascertainment of Early-Onset Sepsis in Late Preterm and Term Neonates
Section snippets
Methods
Lucile Packard Children's Hospital at Stanford is a freestanding, tertiary-care children's hospital with approximately 4500 deliveries annually. Routine newborn care includes couplet care for the mother and neonate with both rooming together in the postpartum unit (ie, newborn nursery). A level II-IV neonatal intensive care unit (NICU) is located adjacent to the postpartum unit. An in-house neonatal hospitalist is available 24 hours per day to attend all high-risk deliveries and evaluate
Results
Since the start of our QI practice change in March 2015, a total of 20 394 neonates at ≥35 weeks of gestation were born at our hospital and followed using a clinical examination-based approach for EOS. The percentage of neonates exposed to ampicillin (Figure, A) decreased from 11.1% in the pre-QI period (373 of 3355) to 4.1% in the QI period (837 of 20 394; P < .001). The use of ampicillin during the sustainability phase of the QI period (3.7%; 370 of 9886) was lower than that in phase I (4.8%;
Discussion
Here we describe the ongoing impact of a clinical examination-based approach for EOS management in late preterm and term neonates at our hospital. Over a period of almost 5 years, implementation of this approach has reduced the use of antibiotics by 63% and reduced sepsis laboratory testing by 59%. The change in practice has been sustained with continuing low rates of antibiotic use and sepsis laboratory testing over the most recent ∼30 months of evaluation. The current report adds to previous
Data Statement
Data sharing statement available at www.jpeds.com.
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2021, Clinics in PerinatologyCitation Excerpt :In data from an earlier era, no cases of meningitis were identified among 284 asymptomatic infants who underwent lumbar puncture because of maternal risk factors.51 The proportion of term infants who are treated for suspected EOS in contemporary studies and found to be bacteremic is at present less than 1%.33,44 In most cases, therefore, and definitively among well-appearing term infants, lumbar puncture can be deferred until blood culture yields a pathogen.
A.F. is a scientific consultant for Takeda Pharmaceuticals. The other authors declare no conflicts of interest.