title: Serial physical examinations, a simple and reliable tool for managing neonates at risk for early-onset sepsis.
abstract: OBJECTIVE
  To investigate whether serial physical examinations (SPEs) are a safe tool for managing neonates at risk for early-onset sepsis (EOS).
  
  
  METHODS
  This is a retrospective cohort study of neonates (≥ 34 wks' gestation) delivered in three high-volume level IIIbirthing centres in Emilia-Romagna (Italy) during a 4-mo period (from September 1 to December 31, 2015). Neonates at risk for EOS were managed according to the SPEs strategy, these were carried out in turn by bedside nursing staff and physicians. A standardized form detailing general wellbeing, skin colour and vital signs was filled in and signed at standard intervals (at age 3, 6, 12, 18, 36 and 48 h) in neonates at risk for EOS. Three independent reviewers reviewed all charts of neonates and abstracted data (gestational age, mode of delivery, group B streptococcus status, risk factors for EOS, duration of intrapartum antibiotic prophylaxis, postpartum evaluations, therapies and outcome). Rates of sepsis workups, empirical antibiotics and outcome of neonates at-risk (or not) for EOS were evaluated.
  
  
  RESULTS
  There were 2092 live births and 1 culture-proven EOS (Haemophilus i) (incidence rates of 0.48/1000 live births). Most newborns with signs of illness (51 out of 101, that is 50.5%), and most of those who received postpartum antibiotics (17 out of 29, that is 58.6%) were not at risk for EOS. Compared to neonates at risk, neonates not at risk for EOS were less likely to have signs of illness (51 out of 1442vs40 out of 650,P= 0.009) or have a sepsis workup (25 out of 1442vs28 out of 650,P< 0.001). However, they were not less likely to receive empirical antibiotics (17 out of 1442vs12 out of 650,P= 0.3). Thirty-two neonates were exposed to intrapartum fever or chorioamnionitis: 62.5% (n= 20) had a sepsis workup and 21.9% (n= 7) were given empirical antibiotics. Among 216 neonates managed through the SPEs strategy, only 5.6% (n= 12) had subsequently a sepsis workup and only 1.9% (n= 4) were given empirical antibiotics. All neonates managed through SPEs had a normal outcome. Among 2092 neonates, only 1.6% (n= 34) received antibiotics; 1.4% (n= 29) were ill and 0.2% (n= 5) were asymptomatic (they were treated because of risk factors for EOS).
  
  
  CONCLUSIONS
  The SPEs strategy reduces unnecessary laboratory evaluations and antibiotics, and apparently does not worsen the outcome of neonates at-risk or neonates with mild, equivocal, transient symptoms.
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Berardi
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Buffagni
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rossi
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Vaccina
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattelani
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gambini
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Baccilieri
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Varioli
authors.affiliation: Alberto Berardi, Anna Maria Buffagni, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari, Neonatal Intensive Care Unit, Department of Mother and Child, Policlinic University Hospital, 41124 Modena, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ferrari
keywords: Group B streptococcus; Intrapartum antibiotic prophylaxis; Newborn; Prevention; Sepsis