Comparing Clinical Practice to Calculated Risks: A Retrospective Study on Early-onset Neonatal Sepsis in a Level-1 Hospital.

Abstract

Background: Early-onset neonatal sepsis (EONS) is a significant cause of morbidity and mortality, traditionally assessed through categorical risk factors. We explore the current incidence of EONS and evaluate the Kaiser Permanente neonatal sepsis calculator's impact on newborn management.

Methods: A retrospective study (2017-2022) at Hospital de Palamós involved 4782 live births. High-risk newborns were identified through International Classification of Diseases, 9th Revision codes and blood culture results. Clinical and cost data were collected, and the Kaiser Permanente calculator's recommendations were compared with clinical practice.

Results: Of 1533 high-risk newborns, 4 had confirmed clinical sepsis (0.84/1000 live births). The calculator recommended routine care for 2. Lowering the screening threshold improved sepsis case identification without a significant increase in interventions. Based on the modified recommendations, clinical observation would have been indicated in 763 (89.7%) of newborns who had a blood culture, in 57 (57%) of newborns who had a lumbar puncture done, and in 69 (56.1%) of newborns who received empiric antibiotics. Compliance correlated with shorter hospital stays [2.5 days (SD, 1.3) vs. 2.9 days (SD, 1.6), P < 0.001] and lower costs [884.1€ (SD, 307.4) vs. 1075.1€ (SD 521.8), P < 0.001).

Conclusion: The Kaiser Permanente calculator, while effective for asymptomatic newborns, required adjustments for those with suggestive clinical signs. Adherence to modified recommendations showed potential benefits, including optimized resource allocation.