Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal

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Variation in Early-Onset Sepsis Risk Assessment in Asymptomatic Term and Near-Term Infants in Portugal

Original Articles

Isabel Sampaio

Division on Neonatology, Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
https://orcid.org/0000-0002-7947-9071

Catarina Duarte

Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
https://orcid.org/0000-0003-3772-1509

Inês Girbal

Division on Neonatology, Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
https://orcid.org/0000-0002-9856-9056

Raquel Gouveia

Division on Neonatology, Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
https://orcid.org/0000-0002-3353-6210

DOI: https://doi.org/10.25754/pjp.2022.25768

Abstract

Introduction: Identification of well-appearing infants at risk for early-onset sepsis presents an ongoing challenge. Several guidelines advise categorical risk assessment strategies, resulting in excessive laboratory tests, admissions, and antibiotic use. Currently, approaches using multivariate risk assessment or serial clinical observation are gaining ground. The primary objective of this study was to describe early-onset-sepsis risk management across a national sample of postnatal wards.
Methods: A Web-based survey was sent to 51 neonatal units in Portugal, between April and June 2021, to assess local management protocol for term and near-term newborns at risk for early-onset sepsis.
Results:  Thirty-four responses were obtained (out of a total of 65 161 deliveries in 2020). Sociedade Portuguesa de Neonatologia guidelines were followed in 17 out of 34 units. Most units (31/34) used categorical risk assessment and three used serial clinical observation. The considered risk factors differed and the most frequently identified included chorioamnionitis (33/34) and prolonged rupture of membranes (31/34). The most frequent timing for sepsis evaluation was between 6 and 12 hours of life and included blood count and C-reactive protein in all units. Most units (29/33) opted for empiric antibiotics, according to clinical assessment and C-reactive protein values. Antibiotic therapy is started in all cases of chorioamnionitis in 12 out of 34 units. Asymptomatic infants with negative cultures are treated for five or more days in 16 out of 34 units, and in 22 units this is done in the neonatal unit. The majority (25/34) considers possible to adopt a serial clinical evaluation approach. Main concerns were local staff resources (16/24).
Discussion: There is wide variability regarding early-onset-sepsis risk assessment in Portugal. Therefore, it is crucial to standardize clinical pathways to avoid unnecessary interventions.