Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation.

TitleStratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation.
Publication TypeJournal Article
Year of Publication2014
AuthorsEscobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, Newman TB, Zupancic J, Lieberman ES, Draper D
JournalPediatrics
Volume133
Issue1
Pagination30-6
Date Published2014 Jan
ISSN1098-4275
KeywordsAge of Onset, Algorithms, Anti-Bacterial Agents, Case-Control Studies, Decision Support Techniques, Female, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Logistic Models, Male, Multivariate Analysis, Prognosis, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Sepsis, Watchful Waiting
Abstract

OBJECTIVE: To define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ≥ 34 weeks' gestation.

METHODS: We conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth. Using a combination of recursive partitioning and logistic regression, we developed a risk classification scheme for EOS on the derivation dataset. This scheme was then applied to the validation dataset.

RESULTS: Using a base population of 608,014 live births ≥ 34 weeks' gestation at 14 hospitals between 1993 and 2007, we identified all 350 EOS cases <72 hours of age and frequency matched them by hospital and year of birth to 1063 controls. Using maternal and neonatal data, we defined a risk stratification scheme that divided the neonatal population into 3 groups: treat empirically (4.1% of all live births, 60.8% of all EOS cases, sepsis incidence of 8.4/1000 live births), observe and evaluate (11.1% of births, 23.4% of cases, 1.2/1000), and continued observation (84.8% of births, 15.7% of cases, incidence 0.11/1000).

CONCLUSIONS: It is possible to combine objective maternal data with evolving objective neonatal clinical findings to define more efficient strategies for the evaluation and treatment of EOS in term and late preterm infants. Judicious application of our scheme could result in decreased antibiotic treatment in 80,000 to 240,000 US newborns each year.

DOI10.1542/peds.2013-1689
Alternate JournalPediatrics
PubMed ID24366992
PubMed Central IDPMC4079292
Grant ListR01-GM-80180-3 / GM / NIGMS NIH HHS / United States