From the Guidelines
The Kaiser Permanente Neonatal Early-Onset Sepsis (EOS) calculator is the evaluation tool associated with reduced antibiotic usage without increased mortality or admission rates in this scenario. I recommend using this calculator to guide management of this newborn. The calculator incorporates maternal risk factors (GBS status, maternal fever, antibiotic administration, ROM duration) and the infant's clinical appearance to generate an individualized sepsis risk score and management recommendations. For this case, input would include the 40-week gestation, maternal GBS positive status, maternal fever of 101.0°F, suspected chorioamnionitis, administration of antibiotics, 6-hour ROM, and the infant's well appearance. Based on the calculator's recommendation, you may be able to observe the infant closely with vital sign monitoring rather than automatically starting empiric antibiotics. This approach has been shown to reduce unnecessary antibiotic exposure by up to 50% in some institutions while maintaining safety 1. The calculator helps distinguish between infants who truly need immediate antibiotic therapy versus those who can be safely monitored, preserving antibiotic stewardship while protecting vulnerable neonates. Key considerations in this case include the mother's GBS positive status and the presence of suspected chorioamnionitis, which increase the risk of early-onset sepsis in the newborn 1. However, the infant's well appearance and the fact that the mother received broad-spectrum antibiotics for 6 hours before delivery are also important factors to consider when determining the need for empiric antibiotic therapy 1. By using the EOS calculator, clinicians can make informed decisions about the need for antibiotic therapy and minimize unnecessary antibiotic exposure, which is essential for reducing the risk of antibiotic resistance and promoting antibiotic stewardship. Some key points to consider when using the calculator include:
- The importance of accurate input of maternal risk factors and infant clinical appearance
- The need to monitor the infant closely for signs of sepsis, even if empiric antibiotic therapy is not initiated
- The potential for the calculator to reduce unnecessary antibiotic exposure while maintaining safety
- The importance of ongoing evaluation and refinement of the calculator to ensure its continued effectiveness in guiding management of newborns at risk for early-onset sepsis.
From the Research
Newborn Evaluations and Antibiotic Usage
The newborn evaluation associated with a reduced usage of antibiotics without increased mortality or admission is:
- Observation for at least 24 hours for signs of sepsis in asymptomatic neonates born to GBS-colonized mothers 2
- Selective administration of antibiotics to newborns, which can reduce neonatal GBS sepsis by as much as 80 to 95 percent 2, 3
Factors Influencing Antibiotic Usage
The following factors can influence antibiotic usage in newborns:
- Maternal GBS status and risk factors 2, 3
- Presence of penicillin allergy in the mother 4
- Results of antibiotic susceptibility testing 4
- Gestational age and postnatal age of the newborn 5
Antibiotic Dosing Recommendations
The American Academy of Pediatrics has developed guidelines for the management of newborns, including dosing recommendations for ampicillin 5
- The recommended dosing for bacteremia is supported by literature, but the dosing for meningitis is not fully supported and may result in supratherapeutic concentrations and increase seizure risk 5