Application of sepsis calculator in newborns with suspected infection

Abstract

Objective: To compare actual antibiotic use to the stratification based on the sepsis calculator in newborns with suspected early onset sepsis (EOS). To investigate differences in EOS risk and vital signs between newborns that received early (<12 h) versus late antibiotics (≥12 h of life).

Methods: Newborns born ≥34 weeks gestation in 2014 treated with antibiotics started within 72 h after birth were included. We calculated the risk per 1000 live births and retrospectively assigned each newborn to one of four recommended categories using the sepsis calculator.

Results: There were 2094 newborns, 111 (5.3%) received antibiotics and 108 newborns were included. The incidence of culture-proven EOS was 0.096%. In 57 newborns, the advice of the sepsis calculator was not to start antibiotic therapy. Antibiotic treatment was started early in 66 (61%) and late in 42 (39%) newborns. In the "late treatment" group, clinical condition deteriorated, including two newborns with culture-proven EOS. Tachypnea and respiratory distress were significantly more present.

Conclusion: Antibiotic use could be reduced by more than 50%. Newborns with initial low sepsis risk score clinically deteriorated beyond 12 h of life. Continuous good clinical observation remains very important. Prospective validation is necessary to evaluate the safety of this approach.

Keywords: Antibiotics; early onset sepsis; infection; newborns; sepsis calculator.