Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: E...Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: Epidemiological, observational, and cross-sectional, with two cohorts of patients. Settings: IESS Quito Sur Hospital at Quito, Ecuador, from February to April of 2020. Participants: This study included 204 newborns, 102 preterm infants, 102 term infants. Results: There are significant differences between late preterm infants and term infants, with a p-value of 0.000 in the prevalence of early sepsis, 70.59% vs. 35.29%. In respiratory distress syndrome between late and term premature infants, significant differences were observed with a p-value of 0.000, the proportion being 55.58% vs. 24.51% respectively. The prevalence of jaundice is higher in term infants with a p value of 0.002, 72.55%, versus 51.96% in late preterm infants, and the mean value of bilirubins in mg/dL was higher in term infants 14.32 versus 12.33 in late preterm infants;this difference is statistically significant with a p value of 0.004. Admission to the NICU is more frequent in late preterm infants with a p-value of 0.000, being 42.16% for late preterm infants vs. 7.84% in term infants;the mean of the hospital days with p-value 0.005, was higher in late preterm infants 4.97 days vs. 3.55 days for term newborns. Conclusion: Due to the conditions of their immaturity, late preterm infants are 2.86 times more likely to present early sepsis than full-term newborns. It is shown that late preterm infants are 2.69 times more likely to have respiratory distress syndrome compared to term infants, therefore, late preterm infants have a longer hospital stay of 4.97 days versus 3.55 days in term infants. Jaundice and mean bilirubin levels are higher in term infants due to blood group incompatibility and insufficient breastfeeding.展开更多
Background Kaiser Sepsis Calculator(KSC)reduces antibiotic use,testing and intravenous infiltrates but there are concerns about the missed early onset sepsis(EOS)cases.We sought to apply the KSC score for culture-posi...Background Kaiser Sepsis Calculator(KSC)reduces antibiotic use,testing and intravenous infiltrates but there are concerns about the missed early onset sepsis(EOS)cases.We sought to apply the KSC score for culture-positive infants retrospectively in infants born in the last 10 years in our hospital.Methods In a retrospective cohort study,the comparison groups were divided into Group A(no antibiotics recommended by KSC)and Group B(antibiotics recommended).Results Overall,17/24(71%)infants would have been started on antibiotics per KSC but 7/24(29%)would not.The initial EOS risk was not significantly different between the groups(Group A vs.Group B:0.44 vs.0.76,P=0.41),but the final risk score was(0.33 vs.9.41,P<0.001).In Group A(no antibiotics),3/7 infants became symptomatic between 9 and 42 hours.Conclusion There may be a potential delay in starting antibiotics in infants that are asymptomatic at birth while using KSC.展开更多
Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,b...Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,between CG149 National Institute for Health and Care Excellence(NICE)guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator(SRC)in a level 2 neonatal unit at a district general hospital(DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS,neonatal clinical examination findings,and microbial culture results for all neonates born at≥34 weeks’gestation between February and July 2019,who were(1)managed according to CG149-NICE guidelines or(2)received PAb within 72 h following birth at a DGH in Winchester,UK.SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period.Of these,19(31.7%)met SRC criteria for antibiotics;20(33.3%)met the criteria for enhanced observations and none had culture-proven sepsis.Based on SRC projections,neonates with’’≥1 NICE clinical indicator and≥1 risk factor’were most likely to have a sepsis risk score(SRS)>3.Birth below 37 weeks’gestation(risk ratio[RR]=2.31,95%confidence interval[CI]:1.02–5.22)and prolonged rupture of membranes(RR=3.14,95%CI:1.16–8.48)increased the risk of an SRS>3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68%in term and near-term neonates in level 2 neonatal units.展开更多
文摘Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: Epidemiological, observational, and cross-sectional, with two cohorts of patients. Settings: IESS Quito Sur Hospital at Quito, Ecuador, from February to April of 2020. Participants: This study included 204 newborns, 102 preterm infants, 102 term infants. Results: There are significant differences between late preterm infants and term infants, with a p-value of 0.000 in the prevalence of early sepsis, 70.59% vs. 35.29%. In respiratory distress syndrome between late and term premature infants, significant differences were observed with a p-value of 0.000, the proportion being 55.58% vs. 24.51% respectively. The prevalence of jaundice is higher in term infants with a p value of 0.002, 72.55%, versus 51.96% in late preterm infants, and the mean value of bilirubins in mg/dL was higher in term infants 14.32 versus 12.33 in late preterm infants;this difference is statistically significant with a p value of 0.004. Admission to the NICU is more frequent in late preterm infants with a p-value of 0.000, being 42.16% for late preterm infants vs. 7.84% in term infants;the mean of the hospital days with p-value 0.005, was higher in late preterm infants 4.97 days vs. 3.55 days for term newborns. Conclusion: Due to the conditions of their immaturity, late preterm infants are 2.86 times more likely to present early sepsis than full-term newborns. It is shown that late preterm infants are 2.69 times more likely to have respiratory distress syndrome compared to term infants, therefore, late preterm infants have a longer hospital stay of 4.97 days versus 3.55 days in term infants. Jaundice and mean bilirubin levels are higher in term infants due to blood group incompatibility and insufficient breastfeeding.
文摘Background Kaiser Sepsis Calculator(KSC)reduces antibiotic use,testing and intravenous infiltrates but there are concerns about the missed early onset sepsis(EOS)cases.We sought to apply the KSC score for culture-positive infants retrospectively in infants born in the last 10 years in our hospital.Methods In a retrospective cohort study,the comparison groups were divided into Group A(no antibiotics recommended by KSC)and Group B(antibiotics recommended).Results Overall,17/24(71%)infants would have been started on antibiotics per KSC but 7/24(29%)would not.The initial EOS risk was not significantly different between the groups(Group A vs.Group B:0.44 vs.0.76,P=0.41),but the final risk score was(0.33 vs.9.41,P<0.001).In Group A(no antibiotics),3/7 infants became symptomatic between 9 and 42 hours.Conclusion There may be a potential delay in starting antibiotics in infants that are asymptomatic at birth while using KSC.
文摘Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,between CG149 National Institute for Health and Care Excellence(NICE)guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator(SRC)in a level 2 neonatal unit at a district general hospital(DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS,neonatal clinical examination findings,and microbial culture results for all neonates born at≥34 weeks’gestation between February and July 2019,who were(1)managed according to CG149-NICE guidelines or(2)received PAb within 72 h following birth at a DGH in Winchester,UK.SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period.Of these,19(31.7%)met SRC criteria for antibiotics;20(33.3%)met the criteria for enhanced observations and none had culture-proven sepsis.Based on SRC projections,neonates with’’≥1 NICE clinical indicator and≥1 risk factor’were most likely to have a sepsis risk score(SRS)>3.Birth below 37 weeks’gestation(risk ratio[RR]=2.31,95%confidence interval[CI]:1.02–5.22)and prolonged rupture of membranes(RR=3.14,95%CI:1.16–8.48)increased the risk of an SRS>3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68%in term and near-term neonates in level 2 neonatal units.
