Neonatal Sepsis Risk Calculator Developed to Lower Use of Antibiotics

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Highlights:

• A research team from Kaiser Permanente has identified a neonatal risk assessment tool
• It was found to lower the need for an invasive blood test among newborns
• It eliminates the need for antibiotics among infants at low risk for infection

A neonatal sepsis risk calculator has been developed by a research team from Kaiser Permanente that has lowered the use of antibiotics by nearly 50%. The study published in the journal JAMA Pediatrics is expected to reduce the exposure to antibiotics among newborns.

Early-onset Neonatal Sepsis

Early-onset neonatal sepsis is a condition in which a newborn baby is at a risk of meningitis or even death due to a systemic bacterial infection caused by an exposure to bacteria from the genital or the gastrointestinal tract of the mother. The risk to the life of the newborns has resulted in the screening for Group B streptococcus with the administration of intra-partum antibiotics for women who may be at risk. This screening test and the use of antibiotics are recommended by the Center for Disease Control (CDC) and Prevention which has led to lowered incidence of early-onset sepsis. The incidence is now only 0.8 per 1,000 births.

‘Neonatal Sepsis risk calculator provides a pain free method of assessment with lowered antibiotic use.’

As a measure of caution,

• About 15 percent of babies are screened for the presence of infection in the blood
• 5 to 8 percent receive antibiotics during the period of waiting for the test results

Director of the Perinatal Research Unit at the Kaiser Permanente Division of Research, Dr. Michael Kuzniewicz, who is the lead author of the study, said that drawing blood from newborns can be unsettling for the parents and result in unnecessary trauma for the baby. The current risk assessment model was developed in order to find a better way to identify infants who may be at risk.

Benefits of Using the Tool

The advantages of using the tool are

• Newborns who are at high risk of acquiring the infection can be detected
• Unnecessary administration of antibiotics among the low-risk group may be avoided
• Avoiding needless blood test among newborns
• Reduced parental trauma

Risk Prediction Model

The research team from Kaiser Permanente, the University of California, San Francisco and the University of Pennsylvania designed a risk prediction model that used information from over 600,000 mothers and their newborns. The data from the study was used to create an online sepsis risk calculator, which can be used by pediatricians to identify babies at high risk and then to design an appropriate treatment strategy.

The risk for early-onset neonatal sepsis is calculated using

• Time of membrane rupture
• Gestational age of the mother
• Body temperature of the mother
• Group B Streptococcus test taken by the mother
• Intra-partum antibiotics that were used

Care Guided by CDC Guidelines

During the period of study, a certain period of care was guided by CDC guidelines (2010 to 2012),which was utilized to understand the significance of the risk assessment tool. The findings of this part of the study that was conducted on 56,000 infants were

• 66 percent decline in blood cultures
• Reduction in blood cultures from 14.4 percent to 4.9 percent
• Decline in antibiotic use was found to be 48 percent
• Reduction to 2.6 percent from 5 percent.

The concern that newborn with the infection remained undetected was resolved when it was found that

• There was no re-admission regarding early onset sepsis
• There was no increase in the use of antibiotics
• The rate of early onset sepsis remained the same

Increased Mother-Child Bonding Time

Newborn babies who needed to have their blood tested would normally be taken to another room, separating them from their mother. This is found to be stressful for the mother as well as the baby, the risk assessment tool avoided the need for separation.

Early exposure to antibiotics is found to increase the risk for autoimmune disorders, asthma as well as obesity later in life. This assessment tool would aid in lowering exposure to antibiotics among the low-risk category.

Prevalence of Use of this Calculator

The assessment tool has been used by clinicians across 189 nations including India, United Kingdom, Australia, Canada, Holland, Israel and Chile. This assessment tool is the result of analysis of big data obtained from the health records of Kaiser Permanente, which has now been found to benefit many newborns across the world

The assessment tool has numerous benefits and advantages over traditional methods of detection of early-onset neonatal sepsis. It will aid in detecting the infection early and without the need for invasive techniques while ensuring that antibiotics are used only when necessary. Such assessment tools could soon be developed for other infections which require the use of antibiotics, to lower the abuse of antibiotic use and reduce risk of antibiotic resistant strains from developing.

References:

1. Early-Onset Neonatal Sepsis - (http://cmr.asm.org/content/27/1/21.full)

Source: Medindia

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