Introduction of the neonatal sepsis calculator at a low-dependency special care nursery in Australia

Abstract

Background: The neonatal early onset sepsis calculator (Sepsis Calculator) is a screening tool for managing neonates at risk of early onset sepsis (EOS). In large tertiary centers it has been found to reduce empiric antibiotic use in newborns with suspected EOS by up to half, without missing EOS confirmed by blood culture.

Aims: To evaluate the effect of implementation of the Sepsis Calculator at a low-dependency special care nursery in Australia on rates of antibiotic treatment for suspected EOS in newborns, and, to determine the compliance rate in applying the Sepsis Calculator.

Methods: We undertook a retrospective medical record audit at The Women's at Sandringham Hospital during two two-month periods; pre- and post-introduction of the Sepsis Calculator. The management of infants suspected of EOS and length of stay post-delivery were compared. Compliance with Sepsis Calculator use was measured.

Results: 526 infants were included: 266 in period 1 and 260 in period 2. There was no significant change in the proportion of infants who received empirical antibiotics for suspected EOS following introduction of the Sepsis Calculator (6 of 266 during period 1; 2.2% vs. 8 of 260 during period 2; 3.1%; p = .558). The median length of stay (LOS) of infants born to GBS positive mothers who received inadequate antibiotic prophylaxis, decreased from 39.5 h (IQR 28.4 to 47.4) to 25.5 h (IQR 22.2 to 34.2), p = .004 after Sepsis Calculator implementation. The compliance rate for Sepsis Calculator use was 82.3% (214 of 260).

Conclusions: While we did not see a reduction in empirical antibiotic use, this is likely due to the already low baseline antibiotic treatment rate at our institution. Further exploration of how the calculator benefits infants and improves care in non-tertiary special care nurseries, including evaluating LOS, is needed.

Keywords: Early onset sepsis, neonatal sepsis calculator, implementation, low-dependency special care nursery.