Leante-Castellanos JL, Pizarro-Ruiz AM, Olmo-Sánchez MP, Martínez-Martínez MJ, Doval-Calvo D. Results of a strategy based on clinical observation of newborns at risk of early-onset neonatal sepsis.
Early Hum Dev 2023;
176:105714. [PMID:
36701928 DOI:
10.1016/j.earlhumdev.2023.105714]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND
Serial clinical observation of asymptomatic newborns at risk of early-onset sepsis is an alternative option for which there is limited scientific evidence.
AIMS
To evaluate the rate of protocol compliance, the impact on blood tests, percentage of hospitalizations and subsequent procedures, and course of diagnosed early-onset sepsis cases of a protocol based on serial clinical observation.
METHODS
Retrospective observational study comparing an 18-month period under this protocol against a previous protocol based on laboratory tests.
SUBJECTS
6895 asymptomatic newborns with over 35 weeks of gestation.
OUTCOME MEASURES
number of evaluations performed on each subject at risk, percentage of patients undergoing blood draws and hospitalization rates.
RESULTS
Some of the evaluations included in the protocol were omitted in 51.6 % of the newborns undergoing the physical examinations. The implementation of this new approach was associated with a decrease in the percentage of patients undergoing blood draws from 16.8 % to 0.7 % (p < 0.001) with no differences in the progression of the five cases of sepsis studied in each period. The serial clinical observation protocol was associated with a significant increase in hospitalizations for suspected infection, although with no difference in the rate of lumbar punctures performed or antibiotic treatments administered.
CONCLUSION
Compliance with the serial clinical observation protocol can be difficult. This approach often detects newborns with abnormal clinical data that are not explained by early-onset sepsis. Clinical observation is a safe option that minimizes the rate of blood draws.
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