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Comment & Response
October 2017

Early-Onset Sepsis Calculator—Risk of Delaying Treatment—Reply

Author Affiliations
  • 1Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland
  • 2Department of Pediatrics, University of California, San Francisco
  • 3The Permanente Medical Group, Oakland, California
  • 4Systems Research Initiative, Division of Research, Kaiser Permanente Northern California, Oakland
  • 5Newborn Care at Pennsylvania Hospital, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 6Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Pediatr. 2017;171(10):1015-1016. doi:10.1001/jamapediatrics.2017.2467

In Reply In any approach to early-onset sepsis (EOS), clinicians must decide whether to start antibiotics in asymptomatic infants or observe for signs of sepsis before initiating treatment. One could treat all infants with risk factors at birth or not treat any until they became symptomatic. Most approaches fall somewhere in between. There is a tradeoff between treating infants with antibiotics who do not have infection and delaying treatment in those who do. Rational decisions require a value judgment based on the perceived utility/harm of these 2 outcomes as well as the probability of infection. An advantage to our approach is that the EOS calculator provides an explicit estimate of infection risk for each infant to help guide such decisions. Other approaches, such as those from the Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics, do not.1-3 While we have set thresholds for a blood culture at a risk of infection of 1 in 1000 and for antibiotics at 3 in 1000, these thresholds can be set differently if clinicians choose to do so.

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