[Skip to Content]
[Skip to Content Landing]
Views 1,954
Citations 0
Original Investigation
September 3, 2019

Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands
  • 2Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
  • 3Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
  • 4Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
  • 5Department of Pediatrics, Stanford University, Stanford, California
  • 6Department of Pediatrics, Children’s Hospital Lucerne, Lucerne, Switzerland
  • 7Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, Australia
  • 8Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, Australia
  • 9Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
  • 10Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
  • 11Department of Pediatrics, Juliana Children’s Hospital, Haga Teaching Hospital, The Hague, the Netherlands
  • 12Science for Life Laboratory, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  • 13Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, United Kingdom
  • 14Department of Pediatrics, Erasmus University Medical Centre-Sophia Children’s Hospital, Rotterdam, the Netherlands
JAMA Pediatr. Published online September 3, 2019. doi:10.1001/jamapediatrics.2019.2825
Key Points

Question  Is there an association between management guided by the neonatal early-onset sepsis calculator and reduction in empirical antibiotic therapy for newborns with suspected early-onset sepsis?

Findings  This systematic review and meta-analysis found that management guided by an early-onset sepsis calculator was associated with a significant reduction in empirical antibiotic therapy compared with conventional management, with a relative risk of 56% in before-after implementation studies. Safety data were limited, but no evidence was found of inferiority compared with conventional management strategies.

Meaning  Management guided by the neonatal early-onset sepsis calculator is associated with a substantial reduction in empirical antibiotic therapy, but more studies are needed to inform on safety.

Abstract

Importance  The neonatal early-onset sepsis (EOS) calculator is a clinical risk stratification tool increasingly used to guide the use of empirical antibiotics for newborns. Evidence on the effectiveness and safety of the EOS calculator is essential to inform clinicians considering implementation.

Objective  To assess the association between management of neonatal EOS guided by the neonatal EOS calculator (compared with conventional management strategies) and reduction in antibiotic therapy for newborns.

Data Sources  Electronic searches in MEDLINE, Embase, Web of Science, and Google Scholar were conducted from 2011 (introduction of the EOS calculator model) through January 31, 2019.

Study Selection  All studies with original data that compared management guided by the EOS calculator with conventional management strategies for allocating antibiotic therapy to newborns suspected to have EOS were included.

Data Extraction and Synthesis  Following PRISMA-P guidelines, relevant data were extracted from full-text articles and supplements. CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) tools were used to assess the risk of bias and quality of evidence. Meta-analysis using a random-effects model was conducted for studies with separate cohorts for EOS calculator and conventional management strategies.

Main Outcomes and Measures  The difference in percentage of newborns treated with empirical antibiotics for suspected or proven EOS between management guided by the EOS calculator and conventional management strategies. Safety-related outcomes involved missed cases of EOS, readmissions, treatment delay, morbidity, and mortality.

Results  Thirteen relevant studies analyzing a total of 175 752 newborns were included. All studies found a substantially lower relative risk (range, 3%-60%) for empirical antibiotic therapy, favoring the EOS calculator. Meta-analysis revealed a relative risk of antibiotic use of 56% (95% CI, 53%-59%) in before-after studies including newborns regardless of exposure to chorioamnionitis. Evidence on safety was limited, but proportions of missed cases of EOS were comparable between management guided by the EOS calculator (5 of 18 [28%]) and conventional management strategies (8 of 28 [29%]) (pooled odds ratio, 0.96; 95% CI, 0.26-3.52; P = .95).

Conclusions and Relevance  Use of the neonatal EOS calculator is associated with a substantial reduction in the use of empirical antibiotics for suspected EOS. Available evidence regarding safety of the use of the EOS calculator is limited, but shows no indication of inferiority compared with conventional management strategies.

×