565 - The FAST project: A new approach to lower-risk chorioamnionitis babies

Poster Number: 565
Publication Number: 565.336

Kathleen Schwabenbauer, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Mary Z. Kish, UPMC Magee Womens Hospital, McKeesport, PA, United States; Andrea Pollack, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Christina M. Long, UPMC Magee-Womens Hospital, White Oak, PA, United States; Alexandra Mastro, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Abeer Azzuqa, UPMC Childrens Hospital of Pittsburgh, Sewickley, PA, United States; Kalyani Vats, University of Pittsburgh School of Medicine, pittsburgh, PA, United States; Burhan Mahmood, UPMC Childrens Hospital of Pittsburgh, Pittburgh, PA, United States; Vignesh Gunasekaran, University of Pittsburgh, Pittsburgh, PA, United States; Joanne Duara, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Michelle Lamary, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Laura Jackson, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Bianca E. LoVerde, Bianca LoVerde, Pittsburgh, PA, United States; Karena Lawrence, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Sharmila Nanda, UPMC Childrens Hospital of Pittsburgh, Morgantown, WV, United States; Anne-Marie Rick, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Kinsey Roth, WVU, Pittsburgh, PA, United States; Joseph J. Schmidhofer, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Thomas A. Hooven, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Toby D. Yanowitz, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: Accurate identification of early-onset sepsis in neonates exposed to chorioamnionitis (CA) is vital for initiation of appropriate and timely therapy. Recent AAP guidance for well-appearing infants >35 wks GA relies on either (1) categorical risk factors, (2) multivariate risk assessment or (3) serial observations with treatment decisions based on clinical findings1. We developed a quality improvement initiative to transition from empiric antibiotic administration in term, well appearing neonates exposed to CA to a protocol of serial clinical observations, titled the Frequent Assessment of Sepsis Tool (FAST).

Objective: Evaluate the success of FAST for well appearing term infants exposed to CA in reducing antibiotic exposure and NICU stay without increasing neonatal morbidity or mortality.

Design/Methods: Infants eligible for FAST are well-appearing at birth, GA ≥ 37 wks, and born after CA. Infants remain with mother for up to 1hr after birth, then are transferred to the Level III NICU for blood culture, CBC, and a minimum of 3hrs of monitoring. Infants who remain well-appearing and have reassuring lab values (Fig 1) return to newborn nursery to room-in. Serial clinical assessments are completed over 48hrs (Fig 2). No antibiotics or additional lab tests are done. Infants who develop signs of sepsis or have a positive blood culture are transferred back to the NICU. We reviewed infant and maternal medical records 7 months after protocol initiation (2/21-9/21).

Results: From Feb-Sept 2021, 115 infants with CA and GA ≥ 37 wks were evaluated. 26 (22%) were directly admitted to the NICU due to clinical signs or labs concerning for sepsis. 89 (77%) started on the FAST protocol. Of these, 72 (81%) were discharged home from newborn nursery without antibiotic administration. 17 (19%) required transfer back to the NICU: 5 with positive blood cultures, 9 with clinical signs concerning for sepsis, and 3 for neonatal issues unrelated to sepsis. Of all infants exposed to CA, 25 (21%) received 36-48hrs of antibiotics and 7 (6%) received ≥1 week of antibiotics. No infants developed severe illness during their birth hospitalization or required readmission for sepsis after discharge.Conclusion(s): Implementation of a clinical screening tool to identify sepsis in well appearing term infants exposed to chorioamnionitis decreased both antibiotic exposure and extended NICU admission from 100% to 27% with no subsequent increase in morbidity or mortality.
Fig 1. Flow diagram for evaluation of chorioamnionitis-exposed infants
Fig 2. Frequent Assessment for Sepsis Tool (FAST): Serial observation form for initially asymptomatic term newborns after chorioamnionitis