การใช้เครื่องคำนวณความเสี่ยงภาวะติดเชื้อในทารกแรกเกิด (Neonatal Sepsis Calculator) เพื่อลดการใช้ยาปฏิชีวนะในทารกที่สงสัยติดเชื้อในโรงพยาบาลสวรรค์ประชารักษ์

Wipat  Udomponglakana

Authors

Wipat Udomponglakana Sawanpracharak Hospital

Keywords:

Early-Onset Neonatal Sepsis (EONS), Neonatal Sepsis Calculator, Antibiotics, Diagnosis, Complications, Mortality

Abstract

Neonatal sepsis is a significant cause of morbidity and mortality in newborns and often leads to the overuse of antibiotics due to its nonspecific clinical presentation. The Neonatal Sepsis Calculator (NSC) is a tool designed to assess the risk of neonatal sepsis and reduce unnecessary antibiotic use. This study aims to evaluate the effectiveness of the NSC compared to the conventional diagnostic approach based on clinical history, physical examination, and laboratory findings, as recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). Reducing unnecessary antibiotic use in suspected neonatal sepsis cases can help mitigate antibiotic resistance, decrease complications, and alleviate the workload of healthcare providers. Additionally, separating mothers and newborns can hinder the establishment of early bonding, which is crucial for postnatal development. Implementing a structured approach to improve the quality of care for infants suspected of Early-Onset Neonatal Sepsis (EONS) can address these issues effectively.

Research Objectives: To compare clinical outcome of using diagnostic tools for appropriate management of suspected EONS vs conventional treatment.
Methods: This randomized prospective cohort study included neonates with a gestational age of ≥34 weeks suspected of EONS, admitted to the neonatal intensive care unit (NICU) and pediatric ward 3 (Sick Newborn) at Sawanpracharak Hospital between January 4, 2023, and October 2, 2024. Data were collected prospectively, comparing two groups: one diagnosed using the NSC and the other using the conventional approach based on clinical history, physical examination, and laboratory findings. Data on antibiotic administration, duration of therapy, blood culture results (Hemo C/S), and clinical outcomes were analyzed using Chi-square tests, Fisher’s exact tests, and logistic regression.

Results: Of the 219 enrolled patients, 10 were excluded due to shock, severe cyanosis, or cardiopulmonary abnormalities, 7 due to pneumothorax, and 3 due to genetic disorders, leaving 199 patients (107 males, 92 females) for analysis. The NSC group comprised 96 patients, while the conventional group included 103 patients. In the NSC group, 39 patients (40.6%) received initial antibiotics, and 12 (12.5%) received antibiotics after 72 hours. The average length of stay (LOS) was 6.33 days, with complications including respiratory failure (25 cases), pneumothorax (5 cases), necrotizing enterocolitis (8 cases), meningitis (1 case), and 1 death (68.9%, 16.4%, 10.7%, 4.1%, and 1.0%, respectively). In the conventional group, 69 patients (67.0%) received initial antibiotics, and 18 (17.5%) received antibiotics after 72 hours. The average LOS was 8.28 days, with complications including respiratory failure (33 cases), pneumothorax (11 cases), necrotizing enterocolitis (14 cases), meningitis (3 cases), and 4 deaths (68.9%, 16.4%, 10.7%, 4.1%, and 3.9%, respectively). Statistical significant differences (p-value<0.01) were observed in favoring NSC group including % of initial antibiotic use, post-72-hour antibiotic administration, LOS, and complications .

Conclusion: EONS is a critical and common condition in neonates. The use of the NSC can improve accuracy, appropriateness of antibiotic therapy and clinical outcome in managing EONS.

Keywords: Early-Onset Neonatal Sepsis (EONS), Neonatal Sepsis Calculator, Antibiotics, Diagnosis, Complications, Mortality.

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