6412 Early onset sepsis management practices in United Kingdom neonatal units: a cross-sectional study

Objectives This study investigates the current practices in managing early onset sepsis (EOS) across neonatal units in the United Kingdom and assesses their alignment with recent evidence-based guidelines. Methods To ensure the statistical significance of our findings, we aimed to obtain an estimate with a 10% margin of error at a 95% confidence level. According to this requirement, a minimum of 64 neonatal units needed to respond to our survey. Our survey encompassed various platforms, including telephonic questionnaires, conferences, and social media, and was conducted between April 2023 – October 2023, as a single-point cross-sectional study. Results Among the 70 units that participated, from 187 units in UK, 60% initiated management using NICE guidelines, and 40% employed a sepsis risk calculator(SRC). A majority (58%) utilized C-reactive protein (CRP) to determine the need for lumbar puncture (LP), while 93% based the duration of antibiotics on CRP levels. Interestingly, all 70 units continued intravenous antibiotics for culture-negative sepsis or high clinical suspicion. In cases of culture-negative sepsis with positive CRP or clinical concerns, 47% preferred a 5-day course, while 10% opted for 10 days. The remaining units varied antibiotic duration between 5–14 days, guided by CRP and clinical presentation. Notably, 98% of units transitioned to intramuscular antibiotics until intravenous access was established, with only one unit opting for oral antibiotics. All units relied on CRP as a sepsis marker, except for one that utilized both CRP and procalcitonin. Conclusion This study highlights the preference for NICE guidelines in EOS management within the UK, with a noticeable rise in sepsis risk calculator usage. CRP emerged as the favoured inflammatory marker for LP and antibiotic duration decisions. Despite compelling evidence supporting oral antibiotics for culture negative early onset sepsis,1 the majority of units maintained the use of intramuscular or intravenous antibiotics for culture-negative sepsis. NICE is superior to SRC in identifying asymptomatic cases. SRC use should accompany high quality observations. Adoption of SRC in UK has the potential to reduce antibiotic use.2 This calls for further exploration into the adoption of evidence-based practices in neonatal sepsis management. References Keij, Fleur M et al. 'RAIN study: a protocol for a randomised controlled trial evaluating efficacy, safety and cost-effectiveness of intravenous-to-oral antibiotic switch therapy in neonates with a probable bacterial infection.' BMJ open vol 2019;9(7)e026688. doi:10.1136/bmjopen-2018-026688. Morris, Rachel, et al. 'Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with NICE guideline CG149 in infants ≥34 weeks' gestation who developed early-onset sepsis.' Archives of disease in childhood. Fetal and neonatal edition vol 2020;105(6):581–586. doi:10.1136/archdischild-2019-317165.