Centers for disease control and prevention guidelines identified more neonates at risk of early-onset sepsis than the Kaiser-Permanente calculator

Abstract

Aim: Our aim was to retrospectively compare how many cases of early-onset sepsis (EOS) would have been predicted by the the Kaiser-Permanente (KP) calculator and the United States Centers for Disease Control and Prevention (CDC) guidelines.

Methods: This observational retrospective cohort study comprised 50 newborn infants with documented EOS who were born at the Kaplan Medical Centre, Israel, between 2001 and 2018. We retrospectively evaluated whether the KP calculator and the CDC recommendations would have recommended antibiotic treatment if they had been implemented within four hours of birth.

Results: EOS was diagnosed in 50 of the 109 877 infants born from 34 weeks of gestation. By four hours of birth, 18 were symptomatic, five had an equivocal clinical status, and 27 were asymptomatic. The KP calculator would have recommended antibiotic treatment for 19 (38%) neonates: 18 who were symptomatic and one who was initially asymptomatic. The CDC guidelines would have recommended antibiotic treatment for 27 (54%) nenonates: those 19 plus all 5 with equivocal status and other 3 who were asymptomatic.

Conclusion: Using the CDC guidelines would have identified more equivocal and asymptomatic EOS cases within four hours of birth than the KP calculator. Enhanced observation is recommended when using the KP calculator.

Keywords: accuracy; diagnostic test; early-onset sepsis; neonates; risk assessment.