Implementing the Sepsis Risk Calculator
Background information from the 2018 AAP Clinical Report.
The Sepsis Risk Calculator (also known as the Kaiser Neonatal Sepsis Calculator and the Early Onset Sepsis Calculator) is a multivariate risk assessment tool that involves synthesis of established risk factors and the newborn clinical condition to estimate each infant’s specific risk of Early Onset Sepsis (EOS). This calculator was developed using information from over 600,000 newborn infants and has subsequently been validated in many sites throughout the world. It has been validated for use in infants delivered at 34 0/7 weeks gestational age or older (although this toolkit is intended for infants 35 0/7 weeks gestational age or older).
The calculator allows input of objective data including gestational age, the highest maternal intrapartum temperature, maternal GBS colonization status, the duration of rupture of membranes, and the type and duration of intrapartum antibiotic therapies. The calculator also includes information about the evolving newborn clinical condition during the first 2 to 4 hours after birth.
The advantages of this multivariate approach
- It provides information about an infant’s individual risk
- It includes only objective data and not a clinical diagnosis of maternal chorioamnionitis
- It results in relatively few well-appearing newborn infants being treated empirically with antibiotic agents
- Implementation of the calculator requires workflow changes and staff education
- Many infants will require closer monitoring off antibiotics to avoid missing cases of EOS
Several CASC Steering Committee members implemented the SRC at their own hospital sites. Below are a number of suggestions and linked resources to help others with implementation of this tool.
“Approximately six months after standardizing antibiotic treatment course durations, we knew if we adopted the SRC it would continue to improve consistency of practice within the pediatric groups.
The proposal to adopt the SRC was presented to the Pediatric Clinical Section. It was approved and implementation was initiated. We found it standardized risk assessment and treatments. We were no longer treating babies who were clinically well with low-risk factors. In addition, it decreased the number of CBC and blood cultures that were drawn. The AUR decreased, stabilized, and has remained within our set goals. The providers were grateful for standardization of practice overall improving newborn care.”
– Carri Montgomery, Director Women’s and Newborn Services, Platte Valley Medical Center
SRC Implementation Resources
SRC Implementation Tips from Platte Valley Medical Center
This is a resource offers suggestions for SRC documentation, team communication, and nurse education during implementation. This is a checklist that will help standardize the process. Sample report sheets are also included. Platte Valley uses two paper tools to help standardize the consistency of the nurses completing the calculator within two hours of delivery. The first is the transition tool. The second is the postpartum normal newborn report sheet.
This handout helps to clarify some of the questions and challenges that may require specific education during implementation of the SRC. It is important to engage help from your IT Department to help with integration of the calculator into the EMR workflow as much as possible, and to make sure that information from the EMR is flowing appropriately to calculator fields.
Sample EOS Guidelines
Guidelines similar to the Sample Guideline linked below, provided by Dr. Laird, are used at many hospitals. This example is meant to be used as a template for centers to begin creating their own EOS management guideline.
Sample Antibiotic Stewardship and Early Onset Sepsis Risk Calculator Guideline for term and late preterm infants (>=35 0/7 weeks) admitted to the well newborn nursery or Neonatal Intensive Care Unit (NICU).
Management of Early Onset Sepsis (EOS) for the Newborn (SCL Health, Women & Children Services)
Sepsis Risk Calculator Implementation and Practice
A Day in the Life: Neonatal Antibiotic Stewardship at Platte Valley Medical Center
A Day in the Life: Neonatal Antibiotic Stewardship at St. Joseph Hospital
The Neonatal Risk Calculator: Development and Implementation (Puopolo, 2017)
Antibiotic Stewardship Newborn Sepsis Webinar: Kaiser Calculator Demo (Perinatal Quality Collaborative of North Carolina, 2017)
Neonatal Blood Culture Collection Resources
It is very important to collect blood cultures correctly so that your team can feel confident about identifying early onset sepsis when it is present. Use the guidance below to optimize blood culture collection whenever it is indicated. When empiric antibiotics are recommended by the SRC, draw a blood culture, and utilize ampicillin and gentamicin. Refer to up to date published print or online references for neonatal dosing. Example references include Lexicomp, Harriet Lane Handbook, and Neofax (online versions are typically accessed through hospital licenses or personal paid subscriptions).
General Recommendations for Optimizing Blood Cultures
The Life of a Blood Culture (PQCNC)
Additionally, as of the writing of this toolkit, these publications included the most recent guidelines for dosing:
- Reference for neonatal ampicillin and penicillin dosing: Puopolo KM, Lynfield R, and Cummings JJ, Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics August 2019, 144 (2) e20191881; DOI: https://doi.org/10.1542/peds.2019-1881
- Reference for intrapartum antibiotic dosing: Committee on Obstetric Practice. Committee Opinion #712. Intrapartum Management of Intraamniotic Infection, Obstetrics and Gynecology, 2017 Aug;130(2):e95-e101. doi:10.1097/AOG.0000000000002236
Quick links to data collection resources are included here. For more information about data collection for Quality Improvement, go to “Creating a Neonatal Antibiotic Stewardship QI Team.” These tools can be uploaded to your computer and opened with Excel.
- Sepsis Calculator Audit Report Template
- AUR Annotated Run Chart Template
- Antibiotic Utilization Rate (AUR) Calculation Guide: FAQ and Examples
- Case review guide
Puopolo KM, Benitz WE, Zaoutis TE; Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of Neonates Born at ≥35 0/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics. 2018;142(6):e20182894. doi:10.1542/peds.2018-2894
Good PI, Hooven TA. Evaluating Newborns at Risk for Early Onset Sepsis. Pediatric Clinics of North America 66 (2019) 321–331. https://doi.org/10.1016/j.pcl.2018.12.003
Achten NB, Klingenberg C, et al. Association of Use of the Neonatal Early-Onset Sepsis Calculator with Reduction in Antibiotic Therapy and Safety: A Systematic Review and Meta-analysis. JAMA Pediatrics 2019 Sep 3;173(11):1032-1040. doi: 10.1001/ jamapediatrics.2019.2825.
Deshmukh M, Mehta S, Patole S. Sepsis calculator for neonatal early onset sepsis – a systematic review and meta-analysis., Journal of Maternal-Fetal and Neonatal Medicine 2019 Aug 11;1-9. doi: 10.1080/14767058.2019.1649650.