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CC BY-NC-ND 4.0 · Am J Perinatol 2024; 41(S 01): e1197-e1204
DOI: 10.1055/a-2001-9012
Original Article

Agreement between an Early-Onset Neonatal Sepsis Risk Calculator and the Colombian Clinical Practice Guideline in Three Tertiary-Care Centers in Bogotá, Colombia

Laura Milena Quintero-Carreño
1   Facultad de medicina, Especialización en pediatría, Fundación Universitaria Sanitas. Bogotá, Colombia
,
Mayra Alejandra Quintero-Palacios
1   Facultad de medicina, Especialización en pediatría, Fundación Universitaria Sanitas. Bogotá, Colombia
,
María Alejandra Palacios-Ariza 
2   Unidad de investigación, Fundación Universitaria Sanitas, Bogotá, Colombia
,
Ana María Morales-Vélez
3   School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
,
Lina María Méndez-Vargas
3   School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
,
Sandra Beltrán-Higuera
4   Departamento de Infectología Pediátrica, Clínica pediátrica; Clínica Colsanitas, Grupo Keralty, Bogotá, Colombia
,
Leslie Ivonne Martínez
5   Unidad neonatal, Clínica Universitaria Colombia; Clínica Colsanitas, Grupo Keralty, Bogotá, Colombia
,
Reynaldo Prieto-Jure
6   Neonatal Care Unit, Hospital Universitario Mayor “Mederi,” Bogotá, Colombia
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Abstract

Objective Clinical practice guidelines (CPG) worldwide help steer the management of early-onset neonatal sepsis (EONS). These documents typically discourage the use of risk assessment tools. However, prior work has shown that the Kaiser Permanente calculator (Early-Onset Sepsis Calculator [EOScalc]) could be a useful tool in EONS risk assessment. This study aimed to determine the agreement between the recommendations of the Colombian EONS CPG and those of the EOSCalc tool in a cohort of newborns in Bogotá, Colombia.

Study Design Multicenter retrospective observational cohort study. We included newborns with a gestational age ≥ 34 weeks who were admitted to the neonatal care unit with a suspected diagnosis of EONS between 2017 and 2019. Agreement between the two tools was examined using Cohen's kappa under two scenarios (unequivocal and cautious).

Results Of the 23.490 live births, 470 (1.71%) were admitted to the neonatal care unit with a presumptive diagnosis of EONS. This diagnosis was confirmed in seven patients by means of blood cultures, with group B streptococcus the most common organism (57%; 95% confidence interval [CI]: 18.4–90.1). A single death occurred among the patients with confirmed EONS (lethality: 14.3%). The overall incidence of EONS was 0.298 per 1,000 live births. After splitting the recommendations into two scenarios regarding antibiotic use, unequivocal and cautious, the agreement between EOSCalc and the CPG was below 15% (6 and 14%, respectively).

Conclusion Recommendations from the Colombian EONS CPG show poor agreement with the EOSCalc, with the latter detecting all newborns with EONS. Although the use of EOSCalc is clinically and administratively advantageous, further prospective studies are warranted to determine the safety of its implementation.

Key Points

  • Colombian EONS CPGs recommend that an outsized number of newborns be given antibiotics.

  • The KP EOSCalc risk assessment calculator shows poor agreement with CPG recommendations.

  • The Colombian CPGs should be updated to include the use of risk assessment calculators.

Keywords

neonatal sepsis - newborn - Early-Onset Sepsis Calculator - practice guideline

Supplementary Material



Publication History

Received: 22 November 2022

Accepted: 09 December 2022

Accepted Manuscript online:
20 December 2022

Article published online:
24 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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