556 - Comparison of management of clinically well infants born at ≥ 35 weeks gestational age to mothers with chorioamnionitis before and after implementation of early onset sepsis calculator

Poster Number: 556

Surichhya Bajracharya, Advocate Children's Hospital - Park Ridge, Des Plaines, IL, United States; Preetha Prazad, Advocate Children's Hospital - Park Ridge, Park Ridge, IL, United States; Catherine Bennett, Advocate Children's Hospital - Park Ridge, Schaumburg, IL, United States

Background: Use of early onset sepsis (EOS) calculator (EOSC) may reduce lab evaluation (LE) and antibiotic (AB) administration without apparent adverse effects in infants born at ≥ 35 weeks gestational age (WGA). Only few studies were done comparing management of infants born to mothers with chorioamnionitis (CA) by retrospective use of EOSC before and prospective use of EOSC after implementation of EOSC in the same center.

Objective: To compare management of infants born to mothers with CA before and after implementation of EOSC in the same center.

Design/Methods: EOSC was implemented in newborn nursery (NBN) in Jan 2021. Data collected retrospectively from mothers with CA and their infants born at ≥35 WGA and admitted directly to NBN from Jan 2019 to Nov 2021. Study population stratified into 2 groups (Figure1): GroupA, infants managed per CDC 2010 guideline prior to EOSC implementation whom EOSC was used retrospectively; GroupB, infants managed by prospective use of EOSC after EOSC implementation. Comparison of EOSC recommendation, blood culture (BC), AB administration and initiation time, length of stay (LOS), neonatal intensive care unit (NICU) admission before discharge was done with Chi-square/fisher’s exact test for categorical variables and t-test/Mann-Whitney test for continuous variables.

Results: Demographics and clinical characters are shown in Table1. Out of 177 infants in GroupA, retrospective use of EOSC decreased BC from 94% to 21% and AB administration from 94% to 13%. In GroupB, 13% received BC and 5% received AB. There was significant delay in AB initiation in GroupB with no significant difference in LOS between 2 groups. Out of 2 BC positive EOS, EOSC recommended AB only in one in GroupA. None of the BC was positive in GroupB (Table2). Saved $57,841 avoiding complete blood cell count, BC and AB in GroupB. No readmission with EOS within 7 days of life among 38% of infants who followed up after discharge in GroupB.Conclusion(s): EOSC could decrease unnecessary LE and AB administration along with health care cost among clinically well infants born to mothers with CA at ≥ 35 WGA. Prospective use of EOSC decreased AB administration more than projected by retrospective usage. Though retrospective use of EOSC missed BC positive EOS, prospective usage of EOSC in the same center didn’t increase NICU admission before discharge. EOSC may delay AB administration for those who appear clinically equivocal or ill later with no significant difference in LOS. Larger prospective studies using EOSC are required including follow up after discharge to confirm not missing of EOS in infants born to mothers with CA.
Figure 1. Stratification of study population
Table 1. Comparison of demographics and clinical characters