Paediatric Research Across the Midlands
Early onset neonatal sepsis
To highlight regional variation in adherence to the Early Onset Neonatal Sepsis (EONS) NICE guideline CG149. To explore benefits of varied practice and identify quality improvement steps to implement within shared network guidelines.
8 standards including two quality statements from NICE; 100% receive antibiotics within 1 hour of decision to treat, 100% have need for antibiotics reassessed at 36 hours.
A multicentre prospective observational study performed within the SSBC and SWMNN networks. Babies with EONS were audited over a four-week period. Baseline data; demographics, risk factors & clinical indicators for sepsis, screening investigations and antibiotic use. Outcome data; time from decision to treat to antibiotic initiation, antibiotic duration and diagnosis of blood culture positive EONS. Compared with local EONS and NICE CG149 guideline.
320 neonates had suspected EONS; 53% were male with a mean±SD gestation of 38.4±2.1 weeks. 93 (29%) did not fulfil criteria for initiation of antibiotics. 313 (98%) received Benzylpenicillin and 310 (97%) Gentamicin: 86 (25%) didn’t receive the recommended dose of Benzylpenicillin, 42 (10%) for Gentamicin. 305 (95%) had a second CRP level, only 203 (67%) had it taken at 18-24hrs. 203/303 (67%) received their first antibiotic dose within 1 hour from time of decision to treat. Blood culture result was unavailable in 98 (30%) by NICE 36 hour target, leading to treatment beyond 48 hours. There was 1 significant positive blood culture for Group B Streptococcus.
Implications for practice
Agreement is required within laboratories across the region to report blood cultures at 36 hours. A regional EONS proforma would prompt adherence to the guideline, currently being trialled at New Cross.
Regional Project Lead: Dr Anna Gregory
Local Project Leads: Dr Helen McDermott
Dr Cathryn Seagrave
Dr Ranvir Dhoot
Dr Andrew Taylor
Dr Daniela Vietan
Mrs Sharon Turnock
Dr Moslehuddin Farid
Dr Celia Exon
Project Supervisors: Dr Bedford Russell
Staffordshire, Shropshire and Black Country Newborn and Maternity Network Audit and Quality improvement competition on 14/3/17
Presented at REASoN