Variation in Sepsis Evaluation Across a National Network of Nurseries.
OBJECTIVE
The extent to which clinicians use currently available guidelines for early-onset sepsis (EOS) screening has not been described. The Better Outcomes through Research for Newborns network represents 97 nurseries in 34 states across the United States. The objective of this study was to describe EOS risk management strategies across a national sample of newborn nurseries.


METHODS
A Web-based survey was sent to each Better Outcomes through Research for Newborns network nursery site representative. Nineteen questions addressed specific practices for assessing and managing well-appearing term newborns identified at risk for EOS.


RESULTS
Responses were received from 81 (83%) of 97 nurseries located in 33 states. Obstetric diagnosis of chorioamnionitis was the most common factor used to identify risk for EOS (79 of 81). Among well-appearing term infants with concern for maternal chorioamnionitis, 51 of 79 sites used American Academy of Pediatrics or Centers for Disease Control and Prevention guidelines to inform clinical care; 11 used a published sepsis risk calculator; and 2 used clinical observation alone. Complete blood cell count (94.8%) and C-reactive protein (36.4%) were the most common laboratory tests obtained and influenced duration of empirical antibiotics at 13% of the sites. Some degree of mother-infant separation was required for EOS evaluation at 95% of centers, and separation for the entire duration of antibiotic therapy was required in 40% of the sites.


CONCLUSIONS
Substantial variation exists in newborn EOS risk assessment, affecting the definition of risk, the level of medical intervention, and ultimately mother-infant separation. Identification of the optimal approach to EOS risk assessment and standardized implementation of such an approach could affect care of a large proportion of newborns.
Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; mukhopadhs@email.chop.edu.
Sagori
S
Mukhopadhyay
Pediatrics, University of Washington School of Medicine, Seattle, Washington.
James A
JA
Taylor
Neonatology, Holy Cross Health, Silver Spring, Maryland.
Isabelle
I
Von Kohorn
Pediatrics, University of California San Francisco, San Francisco, California.
Valerie
V
Flaherman
Pediatrics, Southern California Kaiser Permanente, Downey, California.
Anthony E
AE
Burgos
Pediatrics, Oregon Health & Science University, Portland, Oregon; and.
Carrie A
CA
Phillipi
Academic Pediatric Association, McLean, Virginia.
Nui
N
Dhepyasuwan
Academic Pediatric Association, McLean, Virginia.
Elizabeth
E
King
Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Miren
M
Dhudasia
Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Karen M
KM
Puopolo
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000032:analysis; D002821:Chorioamnionitis; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D000071074:Neonatal Sepsis / Q000175:diagnosis* / Q000188:drug therapy*; D009725:Nurseries, Hospital; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D018570:Risk Assessment / Q000379:methods*; D011795:Surveys and Questionnaires; D014481:United States
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein