A new approach to managing neonates born to mothers at risk for early-onset neonatal sepsis: is it cost-effective and can it reduce NICU admissions?

Introduction: In Minia University Hospital for Obstetrics and Gynecology and Pediatrics (Minia, Egypt), all neonates born to mothers with suspected or confirmed intrauterine inflammation or infection (triple I) or with group B Streptococcus (GBS) bacteriuria, were directly admitted to the neonatal intensive care unit (NICU) for clinical assessment and treatment of suspected sepsis for at least 48 hours, regardless of their clinical condition. Establishment of a risk-identification system for those high-risk neonates based on the EOS detection standard checklist may decrease NICU admissions and antibiotics exposure in asymptomatic neonates. Methods: We marginally altered a standard checklist outlined by The American College of Obstetricians and Gynecologists for the early discovery of neonates at risk for EOS. Participants of the study were inborn neonates 34 weeks born to mothers with suspected or confirmed triple I or with GBS bacteriuria, who received intrapartum antibiotic prophylaxis (IAP) at least 4 hours before delivery. Neonates for mothers at risk for EOS who did not get IAP were excluded from the study. Numerous sessions were conducted to teach nursing and medical staff to apply the standard checklist for the identification of EOS within the nursery. Symptomatic neonates were admitted directly to NICU for laboratory evaluation and intravenous antibiotics. Asymptomatic neonates were closely observed within the nursery. Results: From June 2017 to June 2019, there were 624 at-risk neonates recognized and assessed utilizing the standard checklist. Of these 624 neonates, 456 (73%) did not require admission to the NICU based on their risk assessment utilizing the standard checklist. Implementation of a standard checklist for at-risk neonates decreased NICU rates of admission by 50%, decreased pediatrician practice variability, decreased the number of laboratory procedures, promoted family bonding, increased rates of breastfeeding at hospital discharge, diminished financial burden on the hospital and community, and promoted antibiotic stewardship. Conclusion: This study concludes that utilization of the standard checklist for early identification of EOS can decrease the need for NICU admission of asymptomatic neonates at risk for EOS.