Which newborn evaluation is associated with reduced antibiotic usage without increased mortality or readmission: categorical risk factor assessment, neonatal early onset sepsis (NEOS) calculator, C-reactive protein (CRP) level, complete blood count (CBC) with differential, or blood cultures?

From the Guidelines

The neonatal early onset sepsis (NEOS) calculator is the newborn evaluation associated with reduced antibiotic usage without increased mortality or readmission. This is based on the most recent evidence from 2020, which highlights the effectiveness of the NEOS calculator in estimating an infant's risk of early onset sepsis and guiding antibiotic treatment decisions 1. The key benefits of using the NEOS calculator include:

• Reduced unnecessary antibiotic exposure in newborns by up to 40-50%
• Maintenance of safety outcomes with no increase in mortality or readmission
• More targeted decisions about antibiotic initiation
• Decreased antibiotic resistance, potential adverse effects, separation of mother and baby, and healthcare costs In contrast to traditional methods such as categorical risk factor assessment, CRP level, CBC with differential, or blood cultures, the NEOS calculator provides a more comprehensive and nuanced approach to evaluating the risk of early onset sepsis in newborns. As noted in the study, when using the NEOS calculator, physicians should enter a previous probability of 0.5 out of 1,000, the national risk of early onset sepsis, unless local incidence is known, and consider only penicillin, ampicillin, and cefazolin as specific for GBS treatment 1. Overall, the use of the NEOS calculator represents a significant improvement in newborn evaluation and antibiotic stewardship, and its implementation should be considered as part of a comprehensive approach to managing at-risk infants.

From the Research

Newborn Evaluation and Antibiotic Usage

The following newborn evaluations are associated with reduced antibiotic usage:

• Neonatal Early-Onset Sepsis (NEOS) calculator: + A systematic review and meta-analysis found that the implementation of a sepsis calculator was associated with reduced antibiotic usage 2. + A systematic review evaluated the evidence for the effectiveness of the NEOS calculator as a screening tool to appropriately identify neonatal early-onset sepsis and decrease unnecessary antibiotic use 3. + A systematic review and meta-analysis assessed the association between management of neonatal EOS guided by the NEOS calculator and reduction in antibiotic therapy for newborns 4. + A retrospective review found that the NEOS calculator recommended empiric antibiotics for 23% of those who received therapy, compared with 92% per CDC guidelines 5.
• Combination of NEOS calculator and Universal Serial Physical Examination (SPE): + A prospective two-step implementation of a neonatal EOS prevention protocol found that the combined strategy of universal SPE with the EOS Calculator showed a significant reduction of laboratory tests and antibiotic treatments in term and near-term newborns 6.

Safety Outcomes

The studies found that the use of the NEOS calculator was not associated with increased mortality or readmissions:

• A systematic review and meta-analysis found that there was no difference in mortality, culture positive EOS, and readmissions 2.
• A systematic review found that utilization of the NEOS calculator can reduce empiric antibiotic therapy, unnecessary laboratory testing, and separation of infants and mothers without increasing infant mortality 3.
• A systematic review and meta-analysis found that evidence on safety was limited, but showed no indication of inferiority compared with conventional management strategies 4.
• A retrospective review found that no cases of culture-positive sepsis were identified, but more safety data is needed 5.
• A prospective two-step implementation of a neonatal EOS prevention protocol found that EOS and mortality did not change significantly during the study period 6.