ABSTRACT
BACKGROUND: Rates of neonatal early onset sepsis (EOS) in term infants have recently decreased. The 2018 AAP guidelines for the management of infants at risk for early onset sepsis allows for using a multivariate risk assessment to determine need for empiric antibiotics in infants 35 weeks or greater, including those exposed to chorioamnionitis. METHODS: A quality improvement (QI) project was undertaken to implement use of EOS calculator in chorioamnionitis exposed infants with an aim to safely decrease antibiotic exposure. Multiple Plan-Do-Study-Act (PDSA) cycles occurred to implement the change. Data regarding antibiotics, labs, length of stay and safety metrics were collected. RESULTS: Implementing the EOS calculator's use in chorioamnionitis exposed neonates decreased antibiotic exposure from 100% to 75%, and decreased average duration of antibiotics from 68 to 40 hours. Implementation decreased prolonged courses of antibiotics, lumbar punctures, length of stay and laboratory tests. No cases of early culture confirmed EOS were missed, and none occurred in this well appearing population. CONCLUSIONS: Quality improvement initiatives to implement evidence-based tools can safely and appropriately decrease antibiotic exposure in neonates.
Subject(s)
Anti-Bacterial Agents , Antimicrobial Stewardship , Chorioamnionitis , Neonatal Sepsis , Quality Improvement , Humans , Infant, Newborn , Female , Pregnancy , Chorioamnionitis/drug therapy , Anti-Bacterial Agents/therapeutic use , Neonatal Sepsis/drug therapy , Risk Assessment , Length of Stay/statistics & numerical dataABSTRACT
Currently, 3-10 percent of pregnancies are complicated by abnormal glucose control, and the incidence of diabetes mellitus in the U.S. has risen with the obesity epidemic. Pregnancies affected by diabetes often result in abnormal fetal development, including altered growth and nutrient distribution as well as congenital malformations. Prenatal exposure to the diabetic environment places infants at risk for perinatal compromise, complications in the neonatal period, as well as long term metabolic and neurodevelopmental consequences. It is prudent for providers who care for these newborns to be cognizant of these potential complications in order to promptly and appropriately address them.
