Utilization of a Neonatal Early-Onset Sepsis Calculator to Guide Initial Newborn Management

Bianca M Leonardi; Margaret Binder; Katherine J Griswold; Gulgun F Yalcinkaya; Michele C Walsh

doi:10.1097/pq9.0000000000000214

Utilization of a Neonatal Early-Onset Sepsis Calculator to Guide Initial Newborn Management

Pediatr Qual Saf. 2019 Sep 23;4(5):e214. doi: 10.1097/pq9.0000000000000214. eCollection 2019 Sep-Oct.

Authors

Bianca M Leonardi¹, Margaret Binder², Katherine J Griswold³, Gulgun F Yalcinkaya³, Michele C Walsh^{3

4}

Affiliations

¹ Department of Pediatrics, Akron Children's Hospital, Akron, Ohio.
² Department of Pediatrics, Wake Forest Baptist Health, Winston Salem, N.C.
³ Department of Pediatrics, University Hospitals Cleveland Medical Center'Rainbow Babies, Cleveland, Ohio.
⁴ Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Abstract

Within our hospital system, all infants born to mothers with chorioamnionitis were directly admitted to the neonatal intensive care unit (NICU) for evaluation and treatment of presumed sepsis for a minimum of 48 hours, regardless of clinical appearance. Implementation of a risk-stratification system for thesWe high-risk infants based on the early onset sepsis (EOS) calculator may decrease NICU admissions and antibiotics exposure in well-appearing neonates.

Methods: We used The Model for Improvement as a framework for designing this initiative. Participants were inborn infants 35 weeks and older born to mothers with chorioamnionitis and/or fever. Plan Do Study Act (PDSA) cycles were utilized to educate staff, monitor for sepsis, and follow adherence to the calculator in the newborn nursery.

Results: From June 2015 to June 2016, there were 312 at-risk infants identified and evaluated on the EOS calculator. Of these 312 infants, 228 did not require admission to the NICU based on their risk assessment using the online calculator. Implementation of the Kaiser EOS calculator protocol for at-risk infants decreased NICU admission rates, decreased practitioner practice variability, decreased the number of painful procedures, promoted family bonding, resulted in higher breastfeeding rates at hospital discharge, diminished financial burden, and promoted antibiotic stewardship.

Conclusion: This study demonstrates that the implementation of the sepsis risk calculator at an academic medical center can decrease the number of asymptomatic infants transferred to the NICU for empiric antibiotic treatment.