Retrospective cohort study of neonatal early onset of sepsis and the role of the EOS calculator in a level II nursery.

BACKGROUND: Sepsis is a major cause of mortality and morbidity in neonates. With the improvement in health care standards, the incidence of neonatal Early Onset Sepsis (EOS) has reduced significantly. A recent Web-based EOS-calculator has been introduced with the aim to reduce the use of IV antibiotics in neonates. The role of the EOS-calculator has yet to be ascertained in this regional Special Care Nursery (SCN) in Western Australia. This study aims at examining the local incidence of culture proven EOS and the role of the EOS calculator. METHOD: It is a retrospective study examining all newborns ≥35 weeks gestation throughout 2019 (Jan-Dec 2019) who received IV-antibiotics. The local incidence of culture-proven EOS was established and applied onto the EOS calculator. The recommended management by the EOS-calculator was cross-examined with the local EOS guideline. Overall proportion of reduction in IV antibiotics use was formulated. Other relevant laboratory data extracted was analysed with Pearson's correlation test with the EOS scores. RESULTS: Total included sample was n = 252 with an annual birth of 1880s indicating 13.4% of all neonates born throughout year 2019 was treated with IV antibiotics. The local incidence of culture-proven EOS was 0.5/1000. By applying the EOS-calculator, a significant reduction of IV antibiotics usage from 13.4% to 3.9% (z value 10.4, p < 0.0001) could be achieved in this cohort. Sixty three percent of neonates who received IV antibiotics in this cohort were classified as 'clinically well' based on the EOS-calculator. CONCLUSION: The EOS-calculator could reduce the use of IV antibiotics in the neonatal population significantly in this regional SCN (from 13.4% to 3.9%). Judicial use of IV antibiotics is imperative as part of the holistic care for the neonates. Implementation of the EOS-calculator must be done strategically considering the local incidence of EOS and other health care policies.

Evaluation of a new lancet device (BD QuikHeel) on pain response and success of procedure in term neonates.

OBJECTIVE: To evaluate 2 heel lancet devices in terms of pain response and success of the procedure in neonates undergoing the newborn screening test. DESIGN: Randomized trial. SETTING: Tenth level, mother-and-baby unit of a university-affiliated hospital. Patients Eighty term neonates. INTERVENTIONS: Heel lance using either the BD Safety-Flow lancet (SF) or the BD QuikHeel lancet (QH). MAIN OUTCOME MEASURES: Facial grimacing score (brow bulge, eye squeezed shut, and nasolabial furrow [range, 0%-100%]), cry duration, duration of the procedure, and number of punctures required to collect the blood. RESULTS: Forty neonates were enrolled in each group. There were no differences in the demographic characteristics between groups. During the first skin puncture, the median score (25th-75th percentile) for facial grimacing was 100% (76%-100%) for the SF compared with 73% (42%-100%) for the QH (P =.02). For cry duration, it was 6 seconds (0-9 seconds) vs 0 seconds (0-6 seconds), respectively (P =.01). Pain scores during blood collection (ie, squeezing) did not differ between groups (P =.09). The procedure took less time to perform in the QH group (140 seconds [90-236 seconds]) than in the SF group (215 seconds [137-314 seconds]) (P =.02). The total crying time was shorter in the QH group (90 seconds [66-196 seconds] vs 148 seconds [92-267 seconds]; P =.03). Thirty-six (90%) of the neonates in the QH group received 1 puncture for blood collection compared with 21 (53%) in the SF group (P<.001). CONCLUSION: The BD QuikHeel lancet is superior to the BD Safety-Flow lancet for blood collection in term neonates undergoing the newborn screening test.