Object
The screening of early-onset sepsis in asymptomatic neonates at risk of infection is challenging and remains controversial. The objective of this study was to analyze the impact of standardized and optimized clinical surveillance in a targeted population of neonates at risk of infection, based on the updated Belgian recommendations.
Method
This was a retrospective clinical study comparing two 6-month periods and including all children admitted to maternity. In the first period, neonates at risk of early-onset sepsis were almost always evaluated by blood tests, while in the second period, they were monitored during the first 48 hours using a standardized and optimized clinical evaluation with more targeted indications of blood tests. The main objective was to compare the number of blood tests between the two periods, while the secondary objectives were to compare the numbers of hospitalizations in neonatology and antibiotic treatments.
Results
During the first period, the C-reactive protein (CRP) level was checked in 21.61% of the 1’490 children admitted to the maternity ward, and a whole blood count was performed in 20.54%. In the second period, 26.7% of children (472/1’768) underwent standardized and optimized clinical evaluation; CRP levels were checked in 6.50% (P <0.0001), and whole blood count was performed in 6.05% (P <0.0001). No significant decrease in the number of hospitalizations and antibiotic treatments was observed with the standardized and optimized clinical evaluation. This method caused no delayed diagnosis of sepsis.
Conclusion
Standardized and optimized clinical monitoring of neonates at risk of early-onset sepsis significantly reduces the number of blood tests performed.
What is already known about the topic?
In the management of early-onset neonatal sepsis, blood tests show low sensitivity and specificity and are thus inappropriate screening tools.
What does this article bring up for us?
In order to avoid unnecessary blood tests, this article proposes to implement a standardized and optimized clinical monitoring of neonates at risk of early-onset sepsis in maternity, in accordance with the latest Belgian recommendations.
Key words
Group B Streptococcus, early-onset sepsis, management, clinical monitoring