Early onset sepsis: clinical observation or risk factors approach?

Objectives: To compare the perinatal risk factors approach for early-onset sepsis (EOS), which is based on categorical risk stratification, with the clinical observation-based approach, evaluating their impact on laboratory testing frequency, the use of antibiotic therapy, and EOS incidence.

Methods: Retrospective observational study, conducted from November 2021 to March 2022. Newborns (NB) at 34 wk of age were included and clinical data from prenatal care, birth, hospitalization, and laboratory tests were evaluated.

Results: Sample of 1,086 newborns. Ninety-seven NB (8.9 %) underwent infectious screening in the clinical observation approach versus 279 (26.5 %) in the perinatal risk factors approach, which represents a 65.2 % decrease in the clinical observation approach (p < 0.01). Under the perinatal risk factors approach, 35 (3.2 %) of NBs received empirical antibiotic therapy for EOS, versus only 22 (2.0 %) in the clinical observation approach, which would be a 37.1 % decrease in the clinical observation strategy (p < 0.01). We found no difference in the incidence of culture-confirmed EOS.

Conclusion: The clinical observation approach, when compared to the perinatal risk factors approach, reduces laboratory testing and the use of antibiotic therapy, with no impact on the incidence of EOS. Further research is required to determine the best way to systematize serial examinations of NB's and which symptoms would be the best predictors of EOS.