Search for a command to run...
<h3>Background</h3> The 2012 Neonatal Early Onset Infection Guideline by National Institute for Clinical Excellent (NICE) [CG149], led to an increase in antibiotic use in well newborns. The Kaiser Permanente Sepsis Risk Calculator (KP-SRC) uses the population’s background incidence of EOS, objective information at birth and the infant’s clinical presentation to evaluate risk of neonatal EOS in infants >34 weeks gestation. This has safely shown to reduce the use of antibiotics. During the COVID-19 pandemic, the local Operational Delivery Network endorsed the use of the KP-SRC. <h3>Objectives</h3> To show implementation of KP-SRC can safely and effectively reduce the incidence of antibiotic use in well babies over 34 weeks gestation without an increase in missed cases of sepsis. <h3>Methods</h3> KP-SRC was implemented in 4 neonatal units. KP-SRC is used on all babies with risk factors for infection in accordance with the NICE EOS guideline [CG149] and antibiotics are started according to the recommended outcome. There was slight variation in the parameters used by the units in the calculation of KP-SRC (i.e. Infection incidence rate of 0.8/1000 in 2 units and 0.6/1000 in the other 2 units). Blood culture data during the first seven days of life was provided on a monthly basis by the laboratories. Babies < 34 weeks gestation were excluded and clinical details of the remaining babies were reviewed, particularly with respect to positive blood cultures and readmissions following discharge home. Data was reviewed over a consecutive 5 month period prior to implementation of the KP-SRC (1 Sept 2019 - 31 Jan 2020), and post implementation (1 Sept 2020 - 31 Jan 2021). <h3>Results</h3> There was a percentage reduction in blood cultures taken in the post KP-SRC implementation period between the 4 units of 52 to 85% (mean 60%). There were 5 positive blood cultures, all babies were commenced on antibiotics at birth in accordance with the KP-SRC recommendation. Twenty babies were started on antibiotics after 24 hours of age and received 5 days of antibiotics. Twelve had no risk factors for infection and would not have been picked up by NICE. Of the eight assessed by KP-SRC, two were admitted to the neonatal unit on day 2 with tachypnea but did not require respiratory support. Only one baby was readmitted following discharge and received 5 days of antibiotics. This baby was readmitted on day 7 with apnoea requiring ventilation. There was a history of maternal prolonged rupture of membranes and mild maternal pyrexia but the baby was well in the immediate postnatal period. Blood cultures were negative with normal CRP’s. <h3>Conclusions</h3> The KP-SRC can lead to a safe and consistent reduction in the number of well babies receiving antibiotics post-delivery. All babies with positive blood cultures were on antibiotics as guided by the KP-SRC and there were no missed cases of sepsis.