To the Editor We read with great interest the systematic review and meta-analysis by Achten et al,1 who reported a significant association of using the neonatal early-onset sepsis (EOS) calculator with the substantially reduced use of empirical antibiotics for suspected EOS. The findings of this meta-analysis emphasize the importance of using the neonatal EOS calculator to enhance the accuracy of administrating empirical antibiotic to newborns with suspected EOS, thereby avoiding potential harms and adverse consequences owing to unnecessary empirical antibiotic therapy.2 However, we have 2 methodologic concerns for the meta-analysis by Achten et al,1 which may call to question the authors’ conclusion.