Implementation of Early-Onset Sepsis Calculator-based Evaluation of Newborns in Israel

Background and objective: Early-onset sepsis (EOS) is associated with neonatal morbidity and mortality. Our aim was to evaluate the recommendations based on the EOS calculator in the first two years of its implementation in Israel.

Methods: Prospective two-years` surveillance of a cohort of infants born at gestational age (GA) ≥ 34 weeks in Bnai Zion Medical Center, and were evaluated using the EOS calculator because of peripartum risk factors.

Results: 1146 newborns with peripartum risk factors were evaluated using the EOS calculator. The percentage of infants who had laboratory evaluation dropped to 4.6%, and the EOS calculator recommended empiric antibiotic therapy in only 2.2%. During the study period there were four early-onset infections (EOS incidence of 0.6 in 1000 live births). Three had GBS and one had E.coli. Only two of these infants had perinatal risk factors and the EOS calculator identified them and recommended laboratory evaluation and empiric antibiotics. However, two infants with GBS EOS had no perinatal risk factors or clinical symptoms at delivery, and were discovered clinically at older ages.

Conclusions: The new Israeli EOS calculator-based guidelines seem to be appropriate, and are associated with less laboratory evaluations, and little use of empiric antibiotics. Main concern is related to the current recommendation of no GBS universal screening in Israel, and the inability of the calculator-based approach to identify GBS EOS in newborns to mothers with unknown GBS and no peripartum risk factors before presentation of clinical symptoms.