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Paediatric Research Across the Midlands

Early onset neonatal sepsis

 

Aims

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.

 

Audit standards

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.

 

Method

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.

 

Results 

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

                                          Dr Sivakumar

 

Presentation:                  

Staffordshire, Shropshire and Black Country Newborn and Maternity Network Audit and Quality improvement competition on 14/3/17

 

Presented at REASoN