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Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement

  • Diego Andrés Mazabanda López , Carla Taboada Rubinos , Andrea Hernández Ortega , Lucía del Mar Pérez Guedes , Lourdes Urquía Martí and Fermín García-Muñoz Rodrigo ORCID logo EMAIL logo
Published/Copyright: May 11, 2022
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 50 Issue 8

Abstract

Objectives

The Northern California Kaiser-Permanente Neonatal Sepsis Risk Calculator (SRC) has proved to be safe and effective in reducing laboratory tests, hospital admissions, and administration of antibiotics to patients at risk of early-onset neonatal sepsis (EONS). Many studies have focused on maternal chorioamnionitis as the principal risk factor for EONS. We wanted to know if the use of the SRC could be equally efficient in the context of several other infectious risk factors (IRF), in addition to chorioamnionitis, such as intrapartum maternal fever, GBS colonization and/or prolonged rupture of membranes (PROM).

Methods

Systematic study of neonates with ≥35 weeks gestational age (GA), born in our tertiary university hospital during a period of 18 months. Patients were retrospectively assessed with the SRC and its recommendations were compared with the actual management. A bivariate analysis of perinatal interventions, and outcomes was performed.

Results

A total of 5,885 newborns were born during the study period and 1783 mothers (31%) had at least one IRF. The incidence of culture-proven EONS was 0.5‰. The use of the SRC would have reduced laboratory evaluations (CBC and CRP) from 56.2 to 23.3%, and blood cultures, hospital admissions and antibiotic therapy from 22.9 to 15.5%, 17.8 and 7.6%, respectively. The management based on patients’ symptoms would have shown a reduction to 7.5% in all the outcomes of interest.

Conclusions

Both, the SRC and the management based on clinical findings, are safe and efficient to reduce the number of analytical studies, hospital admissions and administration of antibiotics to neonates with IRF.

Keywords: antibiotic therapy; early-onset neonatal sepsis; infectious risk factors; maternal chorioamnionitis; sepsis workup
Corresponding author: Fermín García-Muñoz Rodrigo, Division of Neonatology, Hospital Universitario Materno-Infantil de Las Palmas, Avenida Marítima del Sur S/N, 35016 Las Palmas de Gran Canaria, Spain, Phone: +34 928444505, Fax: +34 928 444694, E-mail:

  1. Research funding: There was no funding for this research.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: The Authors declare no conflict of interest.

  4. Informed consent: Informed consent was deemed not necessary for this study given the use of anonymized data from medical records as part of the quality control of the healthcare activity.

  5. Ethical approval: The local Institutional Review Board approved the study.

  6. Data availability: Deidentified individual data are available on request.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2021-0372).

Received: 2021-07-27
Accepted: 2022-04-10
Published Online: 2022-05-11
Published in Print: 2022-10-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. WAPM Guideline
  3. Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
  4. Original Articles – Obstetrics
  5. Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
  6. Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
  7. Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
  8. Termination of pregnancy in the second trimester – the course of different therapy regimens
  9. Hyponatremia among preeclampsia patients – a potential sign of severity
  10. Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
  11. Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
  12. Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
  13. The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
  14. Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
  15. Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
  16. Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
  17. Research progress on N6-methyladenosine in the human placenta
  18. Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
  19. Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
  20. Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
  21. Original Articles – Fetus
  22. Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
https://doi.org/10.1515/jpm-2021-0372
Keywords for this article
antibiotic therapy; early-onset neonatal sepsis; infectious risk factors; maternal chorioamnionitis; sepsis workup

Articles in the same Issue

  1. Frontmatter
  2. WAPM Guideline
  3. Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
  4. Original Articles – Obstetrics
  5. Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
  6. Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
  7. Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
  8. Termination of pregnancy in the second trimester – the course of different therapy regimens
  9. Hyponatremia among preeclampsia patients – a potential sign of severity
  10. Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
  11. Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
  12. Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
  13. The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
  14. Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
  15. Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
  16. Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
  17. Research progress on N6-methyladenosine in the human placenta
  18. Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
  19. Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
  20. Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
  21. Original Articles – Fetus
  22. Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
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