Which newborn evaluation is associated with reduced antibiotic usage without increased mortality or relapse?

From the Guidelines

The implementation of a limited diagnostic evaluation, including a blood culture and complete blood count (CBC) with differential and platelets, in newborns born to women with chorioamnionitis, is associated with reduced antibiotic usage without increased mortality or remission rates. When evaluating newborns for potential infections, using this approach allows clinicians to safely discontinue antibiotics earlier in infants who show no clinical signs of infection and have normal laboratory values. This approach is supported by the guidelines for the prevention of perinatal group B streptococcal disease, which recommend a limited evaluation for well-appearing newborns born to women with chorioamnionitis, including a blood culture and CBC with differential and platelets 1. The guidelines also emphasize the importance of considering local antibiotic resistance patterns when selecting empirical antibiotic therapy 1.

Some key points to consider when implementing this approach include:

• The importance of consultation with obstetric providers to determine the level of clinical suspicion for chorioamnionitis 1
• The need for careful monitoring of the newborn for signs of sepsis, with prompt initiation of a full diagnostic evaluation and antibiotic therapy if signs of sepsis develop 1
• The potential for observation at home after 24 hours if other discharge criteria have been met, access to medical care is readily available, and a person who is able to comply fully with instructions for home observation will be present 1

Overall, the use of a limited diagnostic evaluation in newborns born to women with chorioamnionitis can help reduce antibiotic usage while maintaining safety outcomes, and is supported by current guidelines and evidence-based practice 1.

From the Research

Newborn Evaluations and Antibiotic Usage

• The use of serial physical examinations (SPEs) in term neonates at risk of early-onset sepsis has been associated with a reduced usage of antibiotics without increased mortality or remission 2.
• A study found that implementing SPEs for 24-48 hours for neonates with suspected early-onset sepsis reduced antibiotic exposure by 57% and antibiotic therapy-days by 60% without affecting safety 2.
• Another study investigated the safety and efficacy of reducing empiric antibiotic duration to 24 hours for negative early-onset sepsis evaluations in premature infants, finding that it safely reduced antibiotic exposure in 77% of infants 3.

Antibiotic Regimens and Outcomes

• A study compared the use of ampicillin and cefotaxime with ampicillin and gentamicin for neonates at risk of sepsis, finding that the use of ampicillin and cefotaxime was associated with an increased risk of neonatal death 4.
• The use of ampicillin and gentamicin remains the recommended antibiotic regimen for early-onset neonatal sepsis, but potential limitations of this regimen have been identified based on clinical and pathogen characteristics 5.

Optimization of Antibiotic Use

• An antibiotic stewardship program was implemented in a tertiary NICU to optimize antibiotic use for early-onset sepsis, resulting in a significant reduction in empiric antibiotic prescriptions and sepsis evaluations without clinical deterioration in post-intervention infants 6.
• The use of the Neonatal Sepsis Risk Calculator (SRC) and a 36-hour time-out for prescribed empiric antibiotics were key components of the stewardship initiative, which achieved a 29.4% decline in antibiotic prescriptions and a 24.3% decline in sepsis evaluations 6.