Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population
Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population
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DOI：
10.1136/archdischild-2018-316777
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发表时间：
2020-03-01
影响因子：
4.4
通讯作者：
Banerjee, Sujoy
中科院分区：
文献类型：
--
作者：
Goel, Nitin;Shrestha, Sudeep;Banerjee, Sujoy
目的比较英国国家卫生与护理卓越研究所(NICE)和Kaiser Permanente败血症风险计算器(SRC)对早发性新生儿败血症(EONS)风险的管理建议。设计多中心前瞻性投射研究，在英国威尔士的8家妇产科医院设置3个月(2018年2-4月)活产和妊娠34周的患者。方法收集人口学资料、母婴危险因素、婴儿的临床状况、抗生素的使用和出生后72小时的血培养结果。与SRC的预测相比，使用NICE建议和决定管理婴儿。结果在4992名符合条件的婴儿中，3593名(71.9%)获得了完整的数据。其中，576人(16%)是根据NICE建议开始使用抗生素的，而SRC预测的156人(4.3%)，相对减少了74%。在426名避免使用抗生素的婴儿中，SRC只分配了314名婴儿(54.6%)进行常规护理。有七个血液培养呈阳性--三个婴儿被两个人都推荐使用抗生素，三个孩子在无症状阶段都没有被识别出来；一个是污染物。结论在英国临床实践中，明智地采用SRC进行eONS的筛查和管理，可能会减少四分之三的足月或近月儿的干预和抗生素的使用，并促进50%的新生儿提前出院。与NICE相比，我们没有发现SRC遗漏了任何Eons案例。这些结果对医疗资源具有重大影响。
Objective To compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS).Design Multicentre prospective observational projection study.Setting Eight maternity hospitals in Wales, UK.Patients All live births >= 34 weeks gestation over a 3-month period (February-April 2018).Methods Demographics, maternal and infant risk factors, infant's clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC.Main outcome measure Proportion of infants recommended for antibiotics on either tool.Results Of 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction of 74%. Of the 426 infants avoiding antibiotics, SRC assigned 314 (54.6%) to normal care only. There were seven positive blood cultures-three infants were recommended antibiotics by both, three were not identified in the asymptomatic stage by either; one was a contaminant. No EONS-related readmission was reported.Conclusion The judicious adoption of SRC in UK clinical practice for screening and management of EONS could potentially reduce interventions and antibiotic usage in three out of four term or near-term infants and promote earlier discharge from hospital in >50%. We did not identify any EONS case missed by SRC when compared with NICE. These results have significant implications for healthcare resources.