Comparison of Antibiotic Recommendation between Early Onset Neonatal Sepsis Calculator and American Academy of Pediatrics 2018 Guidelines in a Tertiary Hospital

Background: Many neonates are started on antibiotics even if they are well-appearing due to presence of risk factors. The Early Onset Sepsis (EOS) calculator is a web-based tool that calculates for composite risk scores for sepsis and limits empiric antibiotic therapy only as necessary. Objective: This study aims to determine if there is a significant difference between the proportion of neonates recommended for antibiotics using the EOS calculator and AAP guidelines for neonatal sepsis. Methods: This is a retrospective hospital-based cohort study where review of charts of neonates ≥34 weeks age of gestation (AOG) who were started on intravenous antibiotics within 72 hours of life for the period of 2019 to 2023 was done. Peripartum risk factors were used to calculate for EOS risk score and categorize those to be recommended for treatment using the score as well as the AAP guidelines. Newborns with growth on blood culture were identified. McNemar’s test was used to determine if there is a significant difference between the two proportions. Sensitivity and specificity of both tools were calculated. Results: Out of 916 neonates, 345 (38%) and 469 newborns (51%) were advised empiric antibiotic therapy by the EOS calculator and AAP 2018 guidelines respectively. A McNemar Test revealed a significantly lower proportion of neonates recommended for antibiotic treatment using the EOS calculator (p < 0.001). Blood culture was taken from 208 newborns and six had positive isolates. Both the EOS calculator and AAP guidelines had 100% sensitivity and recommended antibiotics for these culture-proven sepsis cases. EOS calculator had a higher specificity (45% vs 32%). Conclusion: The EOS calculator as a risk assessment tool could significantly reduce use of antibiotics. The proportion of those who were recommended for antibiotics using the EOS calculator was significantly lower by 13% (p value = <0.001) compared to those who were recommended for antibiotics using the AAP 2018 guidelines. This proves to be a considerable reduction in the use of antibiotics through the EOS calculator. The EOS calculator also had higher specificity in recommending initiation of empiric antibiotic therapy compared to the AAP 2018 guidelines. Prospective use of the EOS calculator and experimental studies are needed to investigate safety in its use.