title: Early-onset sepsis: a predictive model based on maternal risk factors.
abstract: OBJECTIVE
  Neonatal early-onset sepsis (EOS) is a very low-incidence, but potentially fatal condition among term and late preterm newborns. EOS algorithms based on risk-factor threshold values result in evaluation and empiric antibiotic treatment of large numbers of uninfected newborns, leading to unnecessary antibiotic exposures and maternal/infant separation. Ideally, risk stratification should be quantitative, employ information conserving strategies, and be readily transferable to modern comprehensive electronic medical records.
  
  
  RESULTS
  We performed a case-control study of infants born at or above 34 weeks' gestation with blood culture-proven EOS. We defined the relationship of established predictors to the risk of EOS, then used multivariate analyses and split validation to develop a predictive model using objective data. The model provides an estimation of sepsis risk that can identify the same proportion of EOS cases by evaluating fewer infants, as compared with algorithms based on subjective diagnoses and cut-off values for continuous predictors.
  
  
  CONCLUSIONS
  An alternative approach to EOS risk assessment based only on objective data could decrease the number of infants evaluated and empirically treated for EOS, compared with currently recommended algorithms. Prospective evaluation is needed to determine the accuracy and safety of using the sepsis risk model to guide clinical decision-making.
authors: Department of Newborn Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. kpuopolo@partners.org
authors: Karen M
authors: KM
authors: Puopolo
authors: Gabriel J
authors: GJ
authors: Escobar
mesh_terms: D017668:Age of Onset; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology* / Q000635:transmission
chemical_list: D000900:Anti-Bacterial Agents