ผลจากการใช้เครื่องมือในการคำนวณความน่าจะเป็นของการเกิดภาวะติดเชื้อในกระแสเลือดระยะแรกในทารกแรกเกิด (Neonatal early onset sepsis calculator) ต่อการใช้ยาปฏิชีวนะ ในโรงพยาบาลพหลพลพยุหเสนา

Pimonwan  Kosonrattanapohn

Authors

Pimonwan Kosonrattanapohn Pediatric Department, Phaholpolpayuhasena Hospital

Abstract

Background Early onset sepsis (EOS) is a potentially fatal condition that affects infant born in Thailand. Current algorithms for management of neonatal early onset sepsis (EOS) result in medical intervention for large number of uninfected infants. The Neonatal early onset sepsis (EOS) calculator was developed for estimating the risk of EOS among late preterm and term infants, potential to reduce newborn antibiotic exposed.

Objectives Tostudy the impact of applying the calculator to infant treated for early onset neonatal sepsis who were born more than 34 week gestational age at Paholpolpayuhasena hospital.

Methods We retrospectively review of infants more than34 week gestational age who was born between 1 January - 31 December 2019 and received antibiotic before 72 hour of age. Subjected were compared according to Center for disease control (CDC) 2010 guideline criteria versus the Kaiser Permanente neonatal early onset sepsis calculator recommendation.

Results One hundred and ninety-eight infants were enrolled. Mostly term infants. Median birth weight and duration of antibiotic therapy were 2802 grams and 7 days respectively. Nine positive blood culture (4.5%) was identify. The Neonatal sepsis calculator recommended take blood culture and empiric antibiotic 55% and 47% of those who received therapy respectively, compare with 90.9% and 85.4% per CDC guideline. P value < 0.0001, adjusted odd ratio 0.013 (95% CI 0-0.075)

References

UNICEF Data: Neonatal mortality. URL: https://data.unicef.org/topic/child-survival/neonatal-mortality/Accessed on May 21, 2018.

Polin RA. The committee on Fetus and Newborn. Management of neonates with suspected or proven early onset bacterial sepsis. Pediatrics 2012;129:1006-1015.

Verani JR, McGee L schrag SJ. Prevention of perinatal group b streptococcal disease: revised guidelines from CDC 2010. MMWR Recomm Rep 2010;59(RR-10):1-36

Mukhopadhyay S, Eichenwald EC, Puopolo KM. Neonatal early-onset sepsis evaluations among well-appearing infants: projected impact of changes in CDC GBS guidelines. J Perinatol 2013;33(3):198-205.

Mukhopadhyay S, Dukhovny D, MaoW, Eichenwald EC, Puopolo KM. 2010 perinatal GBS prevention guideline and resource utilization. Pediatrics. 2014;133(2):196-203.

Benjamin DK, Delong ER, Steinbach WJ, Cotton CM, Walsh TJ, Clark RH. Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics 2003;112:543-547.

Cotton CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, Sanchez PJ et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009;123(1):58–66.

Dhudasia MB, Mukhopadhyay S, Puopolo KM. Implementation of the sepsis risk calculator at an academic birth hospital. Hosp Pediatrics. 2018;8(5):243-250.

Mitre E, Susi A, Kropp LE, Schwartz DJ, Gorman GH, Nylund CM. Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood. JAMA Pediatrics. 2018;172(6):180-315.

Kuzniewicz MW, Walsh EM, Li S, Fischer A, Escobar GJ. Development and implementation of an early-onset sepsis calculator to guide antibiotic management in late preterm and term neonates. Jt Comm J Qual Patient Saf. 2016;42(5):232-239.

Puopolo KM, Draper D, Wi S, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128(5):1155-1163.

Kuzniewicz MW, Puopolo KM, Fischer A, Walsh EM, Li S, Newman TB, Kipnis P, EscobarGJ: A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatrics 2017;171:365–371.

Warren S, Garcia M, Hankins C: Impact of neonatal sepsis calculator on antibiotic use within two tertiary healthcare centers. J Perinatol. 2016;00:1-4.

Strunk T, Buchiboyina A, Sharp M, Nathan E, Doherty D, Patole S: Implementation of the neonatal sepsis calculator in an Australian tertiary perinatal center. Neonatology 2018;113:379-382