Evaluation of Early-onset Sepsis Calculator Among Clinically Well Late-preterm and Term Neonates: A Prospective Cohort Study.

BACKGROUND

Kaiser Permanente Northern California Sepsis Risk Calculator (KPNC SRC) is a widely recognized tool for assessing early-onset sepsis (EOS) risk in neonates, reducing diagnostic testing and empirical antibiotic use. This study evaluated its potential utility in a low-middle-income country setting with limited group B Streptococcus screening facilities.

METHODS

This single-center prospective cohort study enrolled 1157 clinically well neonates (≥34 weeks gestation) to compare outcomes under the preexisting local unit policy and a hypothetical application of the KPNC SRC. The outcomes assessed were high-risk clinical monitoring rate, sepsis evaluation rate, empirical antibiotic utilization rate and delayed EOS diagnoses. Statistical analysis included χ 2 tests and Cohen's kappa, with P < 0.05 considered significant.

RESULTS

There was a low agreement between the unit policy and the KPNC SRC (Cohen's kappa = 0.143). Two neonates developed EOS: 1 pyogenic and 1 fungal. Although both the local unit policy and the KPNC SRC predicted the risk of EOS in these 2 neonates, the local unit policy recommended empirical antibiotics for the fungal case, which was unnecessary. Application of KPNC SRC could have reduced empirical antibiotic utilization rate from 0.2% to 0%, and high-risk clinical monitoring rate from 32.4% to 5.2%, though increased sepsis evaluation rate from 0% to 0.3%.

CONCLUSION

With only 1 culture-proven EOS case among 1157 neonates, the sample size was a limitation to draw conclusions on the safety of implementing the SRC. However, the study provided valuable insights, and in our setting, the KPNC SRC could offer an alternative approach in predicting the risk of EOS among term and near-term neonates clinically well at birth, potentially reducing the use of empirical antibiotics, though with a slight increase in laboratory evaluations. No risk assessment tool is flawless, emphasizing the importance of educating parents on warning signs of EOS.