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.
Kuzniewicz MW, Escobar GJ, Puopolo KM. Early-Onset Sepsis Calculator—Risk of Delaying Treatment—Reply. JAMA Pediatr. 2017;171(10):1015–1016. doi:10.1001/jamapediatrics.2017.2467
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