Antibiotic Stewardship for Neonatal Early Onset Sepsis

There is no question that antibiotics can save the lives of infants affected by early onset sepsis (EOS). However, a growing body of research shows antibiotics are being overprescribed for infants without true sepsis who don’t need such aggressive treatment. Furthermore, studies have shown that there are inexplicable, dramatic differences between hospitals in the frequency of antibiotic utilization in newborns (Schulman 2015). Many hospitals have successfully reduced neonatal antibiotic utilization without evidence for increased complications, using quality improvement methodology.

Potential risks for newborns exposed to antibiotics:

  • Higher incidence of allergies and asthma
  • Problems developing healthy intestinal bacteria
  • Increased likelihood of childhood obesity
  • Creation of treatment-resistant bacteria
  • Increased risk of necrotizing enterocolitis in premature neonates

The Centers for Disease Control and Prevention (CDC) estimates that antibiotic-resistant microbes cause > 2.8 million infections, resulting in over 35,000 deaths each year in the United States.

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What can your hospital do?

Simple, straightforward steps can make a big difference in your center’s antibiotic utilization rate (AUR) and create better outcomes for infants in your care. A 2018 American Academy of Pediatrics (AAP) Clinical Report proposed evidence-based approaches to sepsis risk assessment in newborns. The multivariate risk assessment approach endorsed in the Clinical Report has been shown to reduce exposure to antibiotics by almost 50% in some settings, without demonstrated adverse effects such as missed cases of sepsis (Puopolo 2018).

Some recommendations from the AAP and CDC include:

  • Carefully weigh risks and benefits of administering antibiotics in low-risk infants
  • Use a method (such as the Sepsis Risk Calculator) to risk-stratify newborns
  • Stop antibiotics when infection is not confirmed by appropriate cultures
  • In cases of true sepsis, prescribe antibiotics specific to the cultured bacteria
  • Create a guideline that promotes a consistent, evidence-based approach to evaluation and treatment of EOS

Our Approach

Antibiotic Stewardship Toolkit

The Colorado Antibiotic Stewardship Collaborative developed this toolkit of resources to be used by hospitals that would like to implement their own Neonatal Early Onset Sepsis quality improvement initiatives. The toolkit is designed to support teams through a self-directed quality improvement project.

Guidance in this toolkit is specific to the care of neonates age 0-7 days who were born ≥35 weeks gestation.

To get started, we recommend that you:

  • Review the 2018 American Academy of Pediatrics (AAP) Clinical Report
  • Determine which interventions are relevant in your specific setting
  • Utilize the resources in this Neonatal Antibiotic Stewardship Toolkit to begin your Neonatal Early Onset Sepsis antibiotic stewardship improvement journey.

Resources to guide you are included throughout this toolkit. However, you may contact info@cpcqc.org if you have any questions or require additional support.


About the Collaborative

Neonatal Early Onset Sepsis (CASC-NEOS)

In 2015, the CDC and the Vermont Oxford Network (VON) launched a collaborative QI platform for antibiotic stewardship in newborns (Choosing Antibiotics Wisely). CPCQC formed CASC, a statewide collaborative that included 17 Colorado hospitals, to participate in this initiative. When the Choosing Antibiotics Wisely initiative ended, many CASC hospitals continued their work to reduce unnecessary antibiotic exposure in Colorado’s hospitalized newborns through CASC-NEOS.

The CASC-NEOS Steering Committee developed this toolkit to share best practices and lessons learned through the implementation of similar interventions at their hospitals. We would like to thank the Steering Committee members for their contributions to this toolkit and overall commitment to antibiotic stewardship. The list below includes Steering Committee members and the hospitals they worked with to implement neonatal antibiotic stewardship interventions:

Dr. Bobbi Chambers-Hawk

(Neonatologist), Banner Health North Colorado Medical Center

Tracy Heaberlin

(Neonatal Nurse Practitioner), Banner Health North Colorado Medical Center

Dr. Jeff Homann

(Pharmacist), UCHealth Poudre Valley Hospital, UCHealth Greeley, UCHealth Medical Center of the Rockies

Dr. Mary R Laird

(Neonatologist), Children’s Hospital Colorado, Colorado Springs, UCHealth Memorial Hospitals, and Parkview Medical Center

Carri Montgomery

(RN, BSN, MSOL), Director of Women’s and Newborn Center, Platte Valley Medical Center

Melda Musick

(Neonatal Nurse Practitioner), Children’s Hospital Colorado and  Platte Valley Medical Center

Scott Sveum

(Pharmacist), CASC-NEOS Vice-Chair, Saint Joseph Hospital SCL Health

Dr. Pamela Zachar

(Neonatologist), CASC-NEOS Chair

Ready to Make a Difference?

A steady rise in maternal mortality rates and disparities in infant mortality have increased the spotlight on the quality of care delivered by hospitals and their staff. Together, we can address these issues, improve outcomes and reduce preventable deaths in our state.

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