title: Implementation of a protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic use in very low birth weight infants.
abstract: OBJECTIVE
  To analyze the implementation of a protocol proposed by the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA) to improve sepsis diagnosis in very low birth weight newborns.
  
  
  METHODS
  This was a prospective study that evaluated the implementation of a protocol involving clinical and laboratory criteria (hematologic scoring system of Rodwell and C-reactive protein serial measurements), recommended by ANVISA, to improve the diagnosis of neonatal sepsis in very low birth weight newborns. The study included all patients who were born and remained in the neonatal intensive care unit until discharge or death, and excluded those with congenital diseases. The main outcomes measured in newborns before (2006-2007) and after implementation of the protocol (2008) were the rates of early and late-onset sepsis, use of antibiotics, and mortality. Means were compared by Student's t-test and categorical variables were compared by the chi-squared test; the significance level for all tests was set at 95%.
  
  
  RESULTS
  The study included 136 newborns with very low birth weight. There was no difference between groups regarding general clinical characteristics in the studied periods. There was, however, a decrease in the number of diagnoses of probable early-onset sepsis (p<0.001), use of antimicrobial regimens (p<0.001), and overall mortality and infection-related mortality (p=0.009 and p=0.049, respectively).
  
  
  CONCLUSIONS
  The implementation of the protocol allowed improvement of sepsis diagnosis by reducing the diagnosis of probable early-onset sepsis, thus promoting efficient antimicrobial use in this population.
authors.affiliation: Immunologist Physician. Membro Executor da Comissão de Controle de Infecção Hospitalar do Hospital Universitário Antonio Pedro, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil. Electronic address: mdcris@hotmail.com.
authors.forename: Maria Cristina F Guedes
authors.initials: MC
authors.lastname: Pinto
authors.forename: Arnaldo C
authors.initials: AC
authors.lastname: Bueno
authors.forename: Alan A
authors.initials: AA
authors.lastname: Vieira
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D002985:Clinical Protocols / Q000592:standards*; D057186:Comparative Effectiveness Research / Q000592:standards; D062665:Epidemiological Monitoring; D005260:Female; D006077:Government Agencies / Q000592:standards*; D062489:Health Impact Assessment / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000097:blood / Q000134:cerebrospinal fluid; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D009313:National Health Programs / Q000592:standards; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents
keywords: Diagnosis; Diagnóstico; Neonatal sepsis; Recém-nascido de muito baixo peso; Sepse neonatal; Very low birth weight infant