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Sepsis risk prediction model 'cuts antibiotic use in newborns'

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A neonatal sepsis risk calculator developed in the US has safely reduced antibiotic use by nearly 50% in newborns, according to researchers.

Since routine Group B streptococcus screening and intrapartum antibiotics had been introduced for at-risk mothers, incidence of early-onset sepsis had fallen to less than 0.8 per 1,000 births, they said.

“The risk calculator allows mothers and babies to stay together in the days after birth”

Allen Fischer

But about 15% of babies were still evaluated for infection by blood culture and 5-8% received antibiotics while waiting for infection to be ruled out, said the study authors in JAMA Pediatrics.

They noted that a new risk-based approach would better target newborn infants who were at the highest risk of a serious bacterial infection without exposing those at low risk to antibiotics.

Researchers at private health provider Kaiser Permanente, the University of Pennsylvania and the University of California developed a risk prediction model based on data from more than 600,000 babies and their mothers delivered at hospitals in Boston and Northern California.

The resulting online sepsis risk calculator can be used by clinicians to help them decide which infants to evaluate and treat for infection.

The calculator uses gestational age, time from membrane rupture, maternal temperature and GBS testing results, and use of intrapartum antibiotics to calculate the risk of early-onset sepsis.

“We thought there must be a better way to decide which infants were at higher risk”

Michael Kuzniewicz

In their study, researchers compared the period before the implementation of the risk calculator and around 18 months afterwards at Kaiser Permanente’s Northern California birthing centres.

During the calculator period, in which more than 56,000 infants were born, blood cultures to evaluate for infection declined 66%, from 14.4% at baseline to 4.9%. Antibiotic use declined 48%, from 5% at baseline to 2.6%.

Lead study author Dr Michael Kuzniewicz, director of the perinatal research unit at the Kaiser Permanente Division of Research, said: “It’s often unsettling for new parents to have their newborn’s blood drawn or have their babies taken to the neonatal intensive care unit shortly after birth for intravenous antibiotics.

“We thought there must be a better way to decide which infants were at higher risk, and only evaluate and treat those infants,” he said.

But he noted that “an obvious concern” with significantly reducing the percentage of infants receiving evaluations for sepsis at birth or empiric antibiotics was missing a real infection.

The study found no increase in readmissions for early-onset sepsis or an increase in antibiotics given at 24 to 72 hours after birth, and the rate of early-onset sepsis was unchanged – 0.2 to 0.3 per 1,000 births.

Kaiser Permanente

Sepsis risk prediction model cuts antibiotic use in newborns

Allen Fischer (left) and Michael Kuzniewicz

Study co-author Dr Allen Fischer, director of neonatology for Kaiser Permanente in Northern California, said: “By dramatically reducing the use of antibiotics, the risk calculator allows mothers and babies to stay together in the days after birth.

“Instead of admission to the neonatal intensive care unit for intravenous treatment, the babies remain with their mothers, which improves bonding and the initiation of breastfeeding in the first days of life,” he said.

Research has suggested there may be an association between early exposure to antibiotics and an increased future risk of asthma, obesity and autoimmune disorders, noted the researchers.

Use of the calculator has begun to expand outside of Kaiser Permanente, with similar results, said the study authors.

The calculator was implemented as the primary means of newborn sepsis risk assessment in July 2015 by the Children’s Hospital of Philadelphia (CHOP) in Pennsylvania.

“Antibiotic use has declined by about 50%”

Karen Puopolo

Dr Karen Puopolo, another study co-author and medical director at the hospital, said: “Since that time, antibiotic use has declined by about 50%, and our team is now leading an effort to implement the calculator in all 11 birth hospitals affiliated with CHOP.”

In addition, the study authors noted that clinicians in 189 countries accessed the calculator about 250,000 times in 2016. Users were primarily located in the US, but other major users included clinicians in Australia, Canada, the UK, India, Holland, Chile and Israel.

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