Development and Implementation of an Early-Onset Sepsis Calculator to Guide Antibiotic Management in Late Preterm and Term Neonates

摘要

One of the most common management decisions pediatricians face involves early-onset sepsis (EOS). Which infants should be evaluated? Which infants should receive empiric antibiotics? If an infant is clinically ill, the decision is straightforward, as most pediatricians will treat empirically while they await the results of blood cultures or other diagnostic tests. However, in most cases the newborn is well appearing or only has minor physiologic disturbances (tachypnea, temperature instability). In general, the presence of risk factors such as group B Streptococcus (GBS), inadequate intrapartum antibiotic prophylaxis (LAP), maternal chorioamnionitis, and prolonged rupture of membranes (≥ 18 hours) has been used to decide which infants to evaluate with a blood culture and/or treat empirically with antibiotics. However, making a rational decision to evaluate or treat an infant should depend on the probability of infection as well as the cost-benefit relationship between unnecessarily treating uninfected infants and delaying antibiotic treatment in infected infants.