The Comparison Between Management

Recommendation of Neonatal Early Onset Sepsis

Calculator and CDC/AAP Guidelines among Culture-
Proven Early Onset Sepsis admitted at
University of East Ramon Magsaysay Memorial
Medical Center Hospital from January 2013 -
December 2017
Angelia Septiane Beandda, M.D.
Katherine Mae A. Doctor, M.D. Jacqueline Doctor Bernabe, MD, DPPS
 Introduction
• Neonatal sepsis remains a major health problem in developing countries,
including the Philippines, and is the major cause of mortality of newborn
with the mortality rate of 14.2%.
• The initial signs and symptoms of EOS can be difficult to distinguish from
normal newborn variation.
• The estimate of a newborn’s risk of sepsis at birth is crucial for determining
appropriate monitoring, laboratory testing and/or treatment
 Objective
To describe management recommendation using a neonatal early onset
sepsis calculator and the Center for Disease Control (CDC)/American
Academy of Pediatrics (AAP) guidelines among culture proven positive on
neonatal ≥ 34 weeks age of gestation (AOG) treated with EOS.
 Methods

Design A retrospective review study

University of the East Ramon Magsaysay Memorial

Setting Medical Center Inc. (UERMMMCI) newborn unit

331 infants ≥ 34weeks AOG who received

Subjects antibiotics at birth
 Sample Selection
• Inclusion criteria : Infants who have received empiric
antibiotics for early onset sepsis within 72 hours of life
• Exclusion criteria: Infants who received antibiotic therapy
with an indication other than rule out EOS was identified, with
chromosomal abnormalities, or with major congenital
anomalies.
 Data Collection

Mother and Baby ‘s Neonatal Management

Medical Record Sepsis recommendation compare
Calculator to AAP/CDC guideline
 STATISTICAL ANALYSIS
• Data was analyzed using Stata version13 software.
• Mean with standard deviation was used to summarize continuous variables while
categorical data was expressed using counts and proportions.
• To determine change or difference between treatment recommendations of NEOS
calculator and AAP guideline with blood CS, Mc Nemar test was used.
• Management recommendations of culture-proven sepsis were compared between
NEOS calculator and CDC/AAP guidelines using Chi square test.
• Agreement between NEOS calculator and CDC/AAP was determined using Kappa
value of agreement. A p-value <0.05 was used a cut-off for significance.
 RESULTS
• Of the 331 patients who received therapy, only 14.2% were recommended
empiric antibiotics by the EOS calculator, compared to the 39% were
recommended by the CDC guidelines (p=0.0000) (К = 0.372).
• Eleven patients were identified to have culture-positive sepsis.
Results
 DISCUSSION
• A study in Utah by Shakib et al on 698 newborns reported reduced
antibiotic exposure using the EOS calculator.
• A previous research conducted by Carola et al, found out that of 896
newborns treated with empiric antibiotics, the EOS calculator had poor
sensitivity and positive likehood ratio (LR+) when compared with CBC and
CRP in evaluating the possibility of Early Onset Sepsis Calculator.
 DISCUSSION
• Our data suggests that that implementation of the Kaiser Permanente Neonatal
Early Onset Sepsis calculator would result in a 87.2% reduction in the number of
neonates unnecessarily treated with broad-spectrum antibiotics for suspected EOS,
and 65% compared to the CDC and AAP guidelines.
• The CDC guidelines recommended empiric antibiotic treatment in 118 patients
(35%) compared with 43 patients (12.9%) when using the EOS calculator. However
further studies in different settings are warranted, and for the implementation in the
local context we should carefully evaluate its use.
 Conclusion
• The number of infants suspected with EOS and subsequently require
antibiotic use at birth may be dramatically reduced with the use of the
neonatal EOS calculator.
• This leads to a decreased need for laboratory tests and antibiotic stewardship.
• Further prospective trials are recommended.