Episode Details

Episode 165: Early-Onset Sepsis Part 2

Dr. Lovedip Kooner explains how to use the Kaiser Permanente early-onset sepsis calculator and explains other useful tools to assist in the diagnosis of EOS. Dr. Arreaza adds comments about the usefulness of this calculator

Written by Lovedip Kooner, MD. Comments and editing by Hector Arreaza, MD.

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Introduction: As a recap, Early-onset sepsis is diagnosed within 72 hours (or within 7 days, according to some experts) after birth. We talked about GBS as the main culprit of EOS. 28% of EOS by GBS are babies born <37 weeks of age and the mortality rate is 19% at that age. Term infant mortality is 2%. EOS has decreased from 0.37 cases per 1,000 live births in 2006 to 0.23 cases per 1,000 live births in 2015. An interesting fact is that meningitis is diagnosed in 10% of babies with EOS, and 9% of those babies do not have bacteremia. But today we are going to dig deeper into the management by using online tools, particularly the Kaiser Permanente Neonatal EOS calculator. 

Using the Kaiser Permanente (KP) neonatal EOS calculator.

Lovedip: It is a multivariate risk assessment tool that guides us in the management of neonatal early-onset sepsis. The Kaiser Permanente (KP) neonatal EOS calculator combines 2 predictive models. One model is based on risk factors known at birth and the other model is based on the newborn clinical condition during the early hours after birth. 

The risk factors are: gestational age, highest maternal antepartum temperature, maternal GBS status, duration of rupture of membranes, and antibiotics (type and duration). If that sounds familiar, it is. It’s mostly the same information used in the categorical risk assessment, except substituting maternal highest antepartum temperature for chorioamnionitis diagnosis. This information is input into the calculator and two values are obtained. The first value is the EOS risk at birth, the second value is the EOS risk after the clinical exam. The clinical exam is broken down into well-appearing, equivocal, and clinical illness.

The well-appearing baby in general is described as alert and consolable, moving all extremities, good skin color no bruising, except possibly acrocyanosis, hungry and when put on mom’s breast will attempt to suckle, normal vital signs, good reflexes like Moro and grasp, tends to have flexed limbs, especially arms, regards faces  but no tracking. In a previous episode, we mentioned that hypoglycemia is not a good indicator of EOS caused by GBS. Let’s talk about the criteria for a well-appearing baby in the Kaiser Permanente tool.

Well-appearing for the purposes of the KP calculator means no persistent physiologic abnormalities. 

Equivocal means: “Tachy, Tachy, Temp, Resp”

1. Persistent physiologic abnormality > 4 hrs
2. Two or more physiologic abnormalities lasting for > 2 hrs

Note: abnormality can be intermittent.

An ill newborn, in general, is described as having abnormal vital signs, either hyper or hypothermia, tachycardia, bradycardia or arrhythmia, flaccid, doesn’t regard faces, no or muted reflexes and poor suck, mottled color, cyanosis or bruising, petechiae, retractions, nasal flair or poor nasal breathing (with choanal atresia, pinks up only when crying), gasping respirations,  poor bowel sounds, possibly distended OR scaphoid (with atresias will have scaphoid abdomen and with anomalies like TEF depending on type, emesi