Evaluating a Modified Use of the Kaiser Permanente Early-onset Sepsis Risk Calculator to Reduce Antibiotic Exposure: a Retrospective Study.

BACKGROUND: Early-onset neonatal sepsis (EONS) remains an important disease entity due to very serious adverse outcomes if left untreated. Lack of diagnostic tools in identifying healthy from diseased neonates, and clinicians' fear of the missing positive-culture sepsis babies, or babies with clinical sepsis have led to overtreating and unnecessary antibiotic exposure. Kaiser Permanente EONS risk calculator is an internally validated tool that can predict EONS. This sepsis risk calculator (SRC) classifies neonates into three subgroups: (1) ill-appearing, (2) equivocal and (3) well-appearing. We propose a modification to this tool that aims to use it solely for well-appearing babies. This modification represents a more conservative approach to decrease antibiotic exposure and offers an alternative for those hesitant to fully implement this tool. METHODS: This is a dual-centre retrospective study where data were extracted from the electronic medical records. Our primary outcome was to validate the modified use of the SRC with a two-by-two table. Specificity, negative predictive value and expected antibiotic reduction were used to evaluate the tool's feasibility. RESULT: Among 770 babies suspected of EONS, the feasibility of the modified use was tested. The expected antibiotic exposure reduction rate on the modification was 40.4% overall. The proposed modification resulted in a specificity and negative predictive value of 99.28% (95% CI: 97.92% to 99.85%) and 99.5% (95% CI: 99% to 99.8%), respectively. CONCLUSION: The modified use of the sepsis risk calculator has shown that it can safely reduce antibiotic exposure in well-appearing babies. The modified use is used as a 'rule out' test that can identify very low risk of EONS babies, and safely minimise antibiotic exposure. Further prospective studies are needed to examine the efficacy of this use, and quality improvement projects are required to evaluate its applicability in different clinical settings.

Glucose and Lipid Profiles of Overweight and Obese Children in Riyadh, Saudi Arabia.

BACKGROUND: Obesity is a prevalent issue worldwide, affecting both children and adults and posing significant health risks. Obesity and overweight are known to be associated with metabolic abnormalities among children and adolescents. This study aims to determine the metabolic profiles, identifying any abnormalities and related factors among overweight and obese children in Saudi Arabia (SA). METHODS: This study conducted a cross-sectional, descriptive, and analytical analysis on 382 overweight and obese children between the ages of seven and 14 years. The subjects were visitors to pediatric endocrinology clinics and primary healthcare clinics in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Data from the electronic medical records between 2018 and 2020 were examined, focusing on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood sugar (FBS). RESULTS: Among the study sample, 8% were found to have high TC, 19% had high LDL-C, 27% had low HDL-C, 12% had high TG, and 8% had high FBS. Overweight children had higher HDL levels, while obese children had higher TG levels. There was no significant difference between males and females or between different age groups in metabolic profiles. CONCLUSION: This study uncovered a low prevalence of abnormal lipid and FBS profiles among overweight and obese children and adolescents. Detecting and managing the early onset of dyslipidemia and hyperglycemia can prevent long-term consequences and safeguard children from the risk of future cardiovascular injuries and deaths.