6408 Evaluating the use of the kaiser permanente (KP) calculator for neonates at risk of developing early onset sepsis (EOS)

Objectives The Kaiser Permanente (KP) neonatal sepsis calculator is used to assess the risk of Early Onset Sepsis (EOS) in neonates.¹ In September 2022, a neonate scored 'Yellow-Red-Red' (YRR) on the KP calculator. Antibiotics were recommended by the calculator only if examination was equivocal or the baby showed signs of clinical illness. Therefore, antibiotic administration was delayed until the neonate appeared unwell on clinical examination. They were subsequently diagnosed with E.coli meningitis. Following this case, all babies scoring YRR on the KP calculator were audited to investigate the number of additional cases that were 'missed' by the calculator. Methods Retrospective data from one hospital was collected over 6 months from June-November 2022 using online clinical notes. Daily handover sheets were used to find all included babies: i.e. those over 34 weeks gestation, with risk factors for sepsis, scoring YRR on the KP calculator. Three neonates were excluded from the sample since there was insufficient documentation to calculate the KP EOS risk score. Results Out of a total of 2576 babies born over the 6-month period, 117 were treated with antibiotics. 61 babies on the KP pathway had a YRR score, with 18% of those babies screened and treated with antibiotics. Two babies were admitted to the Neonatal Unit, and one baby had E.coli positive blood and CSF cultures. Figure 1 shows the KP EOS risk factors, investigation results, and management outcomes, for all babies scoring YRR that were screened for EOS. Conclusion Although EOS can have severe consequences on the health of the neonate, the use of antibiotics has been linked to health problems such as impaired growth,² asthma,³ and disruption to the gut microbiome,² and increases the global risk of antimicrobial resistance.⁴ Treating all YRR babies with antibiotics would increase the total number of babies on antibiotics by approximately 50%. Alongside the health implications to the neonate, this would also increase total hospital stays and associated financial costs. One neonate out of a total of 61 was found to have culture-positive confirmed sepsis, which reflects the low prevalence of EOS in high income countries.⁵ It is not possible to conclude whether there would have been a different clinical outcome with earlier treatment. Although we cannot draw definitive conclusions about the future management of all YRR babies, this audit provides insight into the clinical use of the KP calculator in a UK hospital. References Neonatal Early Onset Sepsis Calculator, Kaiser Permanente 2023. Uzan-Yulzari A, et al. Neonatal antibiotic exposure impairs child growth during the first six years of life by perturbing intestinal microbial colonization. Nat Commun 2021;12:443. Ortqvist AK, et al. Antibiotics in fetal and early life and subsequent childhood asthma: nationwide population based study with sibling analysis. BMJ 2014;349:g6979. Murray CJL, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 2022;399(10325):629–655. Neonatal infection: antibiotics for prevention and treatment, NICE April 2021.