To the Editor The article by Kuzniewicz et al1 addresses an important issue in neonatal treatment, neonatal sepsis. The sepsis calculator proves to be a useful tool to reduce the use of blood cultures and antibiotics in the evaluation of early-onset neonatal sepsis (EOS). The concern, of course, is missing cases of neonatal sepsis and delaying therapy. Although the authors showed no increase in delayed antibiotic use or readmissions for missed cases of EOS, when analyzing the data provided in the Supplement, we realized that 75% of the culture-positive cases in the baseline study period would not have received antibiotics at birth based on the EOS calculator. In comparison, with use of the US Centers for Disease Control and Prevention 2010 guidelines, only 33% to 62% would not have been treated with empirical antibiotics at birth, variation based on clinician’s interpretation of clinical illness and definition of chorioamnionitis used. As the authors correctly pointed out, no risk factor–based strategy can accurately predict neonatal sepsis, and many infants with culture-positive sepsis had no signs or symptoms. Missing such a large portion of culture-positive cases and a mean delay from blood culture to antibiotic administration by about 6 hours in the EOS calculator period compared with the baseline period raises concerns regarding the effect of such delay in treatment for the individual neonates.
Rajbhandari S, La Gamma EF. Early-Onset Sepsis Calculator—Risk of Delaying Treatment. JAMA Pediatr. Published online August 14, 2017. doi:10.1001/jamapediatrics.2017.2476