We all recognize just how important it is to be on the lookout for early-onset sepsis (EOS) in what may be initially a well-appearing term newborn—but just when do we become concerned and what risk factors would push us to investigate the possibility of EOS are diagnostic and management strategies that are more easily preached than standardized. At least that was the hypothesis that triggered Mukhopadhyay et al. (10.1542/peds.2016-2845) to perform a national web-based survey of 97 nurseries in 34 states regarding EOS risk management strategies with 81 of the nurseries responding to the surveys from 33 states. So are all the nurseries using AAP or CDC guidelines on how to evaluate babies if there is material chorioamnionitis, or other tools or scoring systems to measure sepsis risk? If there are risk factors, what are they? Are there common lab tests used? If sepsis is being evaluated, what antibiotics are used and for how long? I realize this blog offers more questions than answers –but suffice it to say, variability in how we handle EOS by state and nursery is the currency of the realm when you read this study. Even whether mothers and infants get separated from each other as part of an EOS evaluation differs between nurseries, making this study a call to uniformity with a more standardized approach needed for quality reasons not to mention potential cost-savings as well if the evidence used to generate clinical guidelines shows a more value-based approach than each individual nursery doing something different. To add further perspective on what this study indicates and how much better we can do in developing a stronger more consistent approach to EOS, check out the commentary by neonatologist and editorial board member Dr. Jim Cummings (REF). The take home point from this study and commentary is that if you see one nursery with a well-appearing baby at risk for sepsis—you’ve seen one nursery and that needs to change. Hopefully after reading this study, it will!
