Utilization of a Neonatal Early-Onset Sepsis Calculator to Guide Initial Newborn Management.

Within our hospital system, all infants born to mothers with chorioamnionitis were directly admitted to the neonatal intensive care unit (NICU) for evaluation and treatment of presumed sepsis for a minimum of 48 hours, regardless of clinical appearance. Implementation of a risk-stratification system for thesWe high-risk infants based on the early onset sepsis (EOS) calculator may decrease NICU admissions and antibiotics exposure in well-appearing neonates. METHODS: We used The Model for Improvement as a framework for designing this initiative. Participants were inborn infants 35 weeks and older born to mothers with chorioamnionitis and/or fever. Plan Do Study Act (PDSA) cycles were utilized to educate staff, monitor for sepsis, and follow adherence to the calculator in the newborn nursery. RESULTS: From June 2015 to June 2016, there were 312 at-risk infants identified and evaluated on the EOS calculator. Of these 312 infants, 228 did not require admission to the NICU based on their risk assessment using the online calculator. Implementation of the Kaiser EOS calculator protocol for at-risk infants decreased NICU admission rates, decreased practitioner practice variability, decreased the number of painful procedures, promoted family bonding, resulted in higher breastfeeding rates at hospital discharge, diminished financial burden, and promoted antibiotic stewardship. CONCLUSION: This study demonstrates that the implementation of the sepsis risk calculator at an academic medical center can decrease the number of asymptomatic infants transferred to the NICU for empiric antibiotic treatment.

An evidence-based overview of prenatal consultation with a focus on infants born at the limits of viability.

Before the delivery of a premature infant, a prenatal consultation between parents and physicians provides the opportunity to establish a trusting relationship and create a supportive environment for decision-making concerning neonatal resuscitation. The ideal consult enables physicians to educate parents about preterm delivery and potential outcomes for their infant while providing parents with the time to ask questions and express their values. The uncertainty that surrounds many decisions in the treatment and resuscitation of infants born at the limits of viability creates a situation in which joint responsibility for decision-making between parents and physicians is vital. In this review we examine ethical considerations regarding the resuscitation of infants born at the limits of viability and present the current policies established by the Neonatal Resuscitation Program and the American Academy of Pediatrics. The parental and physician perspectives regarding the consultation experience are presented also. Finally, a model for the prenatal consultation is introduced with suggestions for the incorporation of morbidity and mortality data as well as the structure and approach to discussion with parents with threatened preterm delivery.