Abstract Objective: Early-onset sepsis (EOS) is a significant cause of neonatal morbidity and mortality. Due to fear of missing cases, many newborns are unnecessarily exposed to antibiotics. We implemented the neonatal EOS calculator to reduce over-utilization of antibiotics and decrease costs. Design: Quality improvement study. Setting: Neonatal Intensive Care Unit (NICU). Patients: Infants born at ≥34 weeks’ gestation were divided between two periods: the pre-EOS calculator time frame and the post-EOS calculator time frame. Intervention: We changed our EOS evaluation for inborn infants by implementing the EOS-calculator and decreasing “rule-out sepsis” time frame from 48 to 36 hours for infants started on antibiotics. Results: 1, 306 infants, with similar demographics, were included: 814 in pre-EOS calculator time frame and 492 in post-EOS calculator time frame. Following our interventions, the percentage of NICU admissions ≥34 weeks’ gestation started on antibiotics decreased from 62% to 51% (P <. 01). In the chorioamnionitis subgroup, antibiotic starts decreased by 50% (P <. 01). There was a reduction in days of therapy per 1, 000 NICU (168 vs 110, P <. 01) and total (93 vs 57, P <. 01) patient days. Fewer patients had blood cultures drawn (84% vs 67%, P <. 01) with a decrease in infants treated for culture-negative sepsis (7% vs 3%, P <. 01). NICU and hospital length of stay reduced by 1 day (P <. 01), equivalent to a savings of 916, 000 to 1. 84 million per 1, 000 NICU patients in costs and savings of 5. 82 million to 12. 5 million per 1, 000 NICU patients in charges. Conclusions: Antibiotic usage significantly decreased, with substantial savings after implementation of the EOS calculator, without significant negative effects.
Hussain et al. (2026) studied this question.