Neonatal Early-Onset Sepsis Risk Prediction

 

Input
 

Local incidence EOS	Pull down 0.1/1000 births (38.952265) 0.2/1000 births (39.646367) 0.3/1000 births (incidence at KPNC) (40.0528) 0.4/1000 births (40.3415) 0.5/1000 births (national incidence per CDC) (40.5656) 0.6/1000 births (40.7489) 0.7/1000 births (40.903919) 0.8/1000 births (41.0384) 0.9/1000 births (41.1571) 1/1000 births (41.263432) 2/1000 births (41.965852) 4/1000 births (42.676976)
Gestation weeks	Pull down 34 weeks 35 weeks 36 weeks 37 weeks 38 weeks 39 weeks 40 weeks 41 weeks 42 weeks 43 weeks
Gestation days	0 days 1 day 2 days 3 days 4 days 5 days 6 days
Highest antepartum maternal temperature		Cel Degrees C Degrees F degC degF
Hours since ROM		days day hrs hr minutes min seconds second sec s
Maternal GBS status	Negative (0)
	Positive (0.5771)
	Unknown (0.0427)
Intrapartum antibiotics	Broad spectrum ≥4 hours prior to birth (-1.18610)
	Broad spectrum 2 to 3.99 hours prior to birth (-1.0488)
	GBS specific ≥2 hours prior to birth (-1.0488)
	None or any antibiotic <2 hours prior to birth (0)
Clinical exam LR	Well appearing (0.41)
	Equivocal exam (5)
	Ill appearing (21.2)

 

Results
 
Important: Inputs must be complete to perform calculation.

 

EOS risk at birth		per 1000 births
EOS risk after exam		per 1000 births
Decimal Precision   0 1 2 3

 

 

Recommendations Based on EOS Risk[1]

 

EOS Risk per 1000 Births	Recommendations
Exam EOS <1 and birth EOS <1	No culture, no antibiotics, routine vitals
Exam EOS <1 and birth EOS ≥1	No culture, no antibiotics, vitals q4 hours for 24 hours
Exam EOS ≥1 and <3	Blood culture, no antibiotics, vitals q4 hours for 24 hours
Exam EOS ≥3	Empiric antibiotics, vitals per NICU
Exam EOS <3 but ill appearing	Strongly consider empiric antibiotics, vitals per NICU

 

 

 

 

Notes

• Criteria for selecting the Ill Appearing LR
  • Need for HCPAP, HFNC, or mechanical ventilation
  • Need for vasoactive drugs
  • Encephalopathy, perinatal depression, seizures, or 5-minute Apgar <5
  • Need for O₂ support for 2 or more hours to keep oxygen stauration ≥90%
• Criteria for selecting the Equivocal exam LR
  • Heart rate ≥160
  • Respiratory rate ≥60
  • Temperature ≥100.4 degF or <97.5 degF
  • Respiratory distress
• EOS: Early-onset sepsis; ROM: rupture of membranes; GBS: group B strep; LR: likelihood ratio; NICU: neonatal intensive care unit.

 
Equations used
 

EOSrisklogit = LocalincidenceEOS + (0.868 * Highestantepartummaternaltemperature) - (6.9325 * (Gestationweeks + (Gestationdays / 7))) + (0.0877 * sq(Gestationweeks + (Gestationdays / 7))) + (1.2256 * HourssinceROM+0.050.2) + Intrapartumantibiotics + MaternalGBSstatus

EOSriskatbirth = 1000 / (1 + e(-EOSrisklogit))

EOSoddsafterexam = e(EOSrisklogit) * ClinicalexamLR

EOSriskafterexam = 1000 * EOSoddsafterexam / ( 1 + EOSoddsafterexam)

 

 

Calculation Details and Variables

• Equation parameters such as Maternal GBS status, have two or more discrete values that may be used in the calculation. The numbers in the parentheses, e.g. (0), represent the values that will be used.

 

References

1. Puopolo KM, Draper D, Wi S, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011 Nov;128(5):e1155-63. PubMed ID: 22025590
2. Kuzniewicz MW, Walsh EM, Li S, et al. Development and Implementation of an Early-Onset Sepsis Calculator to Guide Antibiotic Management in Late Preterm and Term Neonates. Jt Comm J Qual Patient Saf. 2016 May;42(5):232-9. PubMed ID: 27066927