Performance of Early-Onset Sepsis Calculator in Neonates With Respiratory Distress After Birth

BACKGROUND AND OBJECTIVE Respiratory distress in late preterm and term neonates is often considered a sign of early-onset sepsis (EOS). While there are numerous other causes of respiratory distress in the neonatal period, affected infants are often evaluated for EOS and treated with empirical antibiotics. One of the tools used for EOS evaluation and use of empirical antibiotics is the Kaiser Permanente EOS calculator. Our objective was to determine the incidence of EOS in late preterm and term neonates with respiratory distress and to determine the performance of the EOS calculator. METHODS This retrospective study included 638 neonates born with at least 35 weeks’ gestation admitted to the neonatal intensive care unit with respiratory distress at a tertiary care hospital between April 2017 and June 2024. Demographic, clinical, and laboratory data were extracted from electronic medical records. The incidence of EOS was evaluated, and the performance of the EOS calculator was compared with management guided by clinical assessment. RESULTS A total of 638 infants were included; 594 (93.1%) had isolated respiratory distress. Only 3 infants (0.47%) had culture-positive EOS. The EOS calculator recommended empirical antibiotics or strong consideration of empirical antibiotics in 565 infants (88.6%), whereas the medical team initiated empirical antibiotics in only 392 infants (61.4%) (P < .001). Blood cultures were sent in 509 infants (79.8%). CONCLUSION The prevalence of EOS in neonates with respiratory distress is low despite widespread laboratory testing and empirical antibiotic use. A management approach guided by the EOS calculator, while helpful, may lead to an increase in antibiotic use.