{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:32:20Z","timestamp":1789695140962,"version":"4.0.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early-onset neonatal sepsis (EONS) is a major concern in at-risk term and late preterm infants. The American Academy of Pediatrics (AAP) recommends categorical risk assessment (CRA), the sepsis risk calculator (SRC), or serial observation. We compared a local protocol initiating antibiotics only with predefined clinical signs together with abnormal interleukin-6 (IL-6) and\/or C-reactive protein (CRP) with modeled CRA- and SRC-recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort of neonates \u226534 weeks with \u22651 EONS risk factors at Vienna General Hospital (February\u2013July 2024). Infants were managed per local protocol; CRA and SRC were applied retrospectively. Primary outcomes were blood sampling and empiric antibiotics. Given the single culture-positive case, diagnostic performance metrics were treated as exploratory and descriptive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 184 infants, 43 (23%) had clinical signs and 1 (0.5%) had positive blood-culture. Under the local protocol, 56 (30%) underwent blood sampling, and 25 (14%) received antibiotics. CRA and SRC would have recommended empiric antibiotics for 46 (25%) and 36 (20%) infants, respectively. Thus, the local protocol increased sampling but reduced antibiotic exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this low-incidence cohort, the local protocol reduced empiric antibiotic exposure compared with CRA and SRC; findings primarily inform specificity\/stewardship and do not support conclusions regarding sensitivity or clinical safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>In at-risk neonates \u226534 weeks\u2019 gestation, a biomarker-augmented local protocol was associated with lower empiric antibiotic use than AAP categorical risk assessment and the sepsis risk calculator in this low-incidence cohort.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>This real-world study from a European tertiary center directly compares three endorsed EONS strategies within the same contemporary cohort.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Combining structured risk assessment with selective biomarker testing may support antimicrobial stewardship, but the limited specificity of biomarkers at applied thresholds requires careful interpretation alongside the clinical presentation.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41390-026-05120-2","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:38:53Z","timestamp":1779165533000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparing early-onset sepsis risk: risk calculator, American Academy of Pediatrics guidelines, and local care"],"prefix":"10.1038","author":[{"given":"Sophie J.","family":"Jansen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia M.","family":"E\u00dfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Farr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Rittenschober-B\u00f6hm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"5120_CR1","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1097\/INF.0b013e318223bad2","volume":"30","author":"EJ Weston","year":"2011","unstructured":"Weston, E. J. et al. The burden of invasive early-onset neonatal sepsis in the United States, 2005\u20132008. Pediatr. Infect. Dis. J. 30, 937\u2013941 (2011).","journal-title":"Pediatr. Infect. Dis. J."},{"key":"5120_CR2","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/MOP.0000000000000338","volume":"28","author":"CM Cotten","year":"2016","unstructured":"Cotten, C. M. Adverse consequences of neonatal antibiotic exposure. Curr. Opin. Pediatr. 28, 141\u2013149 (2016).","journal-title":"Curr. Opin. Pediatr."},{"key":"5120_CR3","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1093\/jac\/dkx426","volume":"73","author":"JW Fjalstad","year":"2018","unstructured":"Fjalstad, J. W., Esaiassen, E., Juvet, L. K., van den Anker, J. N. & Klingenberg, C. Antibiotic therapy in neonates and impact on gut microbiota and antibiotic resistance development: a systematic review. J. Antimicrob. Chemother. 73, 569\u2013580 (2018).","journal-title":"J. Antimicrob. Chemother."},{"key":"5120_CR4","doi-asserted-by":"publisher","first-page":"1969","DOI":"10.1038\/s41390-022-02329-9","volume":"93","author":"E K\u00fcng","year":"2023","unstructured":"K\u00fcng, E., Unterasinger, L., Waldh\u00f6r, T., Berger, A. & Wisgrill, L. Cut-off values of serum interleukin-6 for culture-confirmed sepsis in neonates. Pediatr. Res. 93, 1969\u20131974 (2023).","journal-title":"Pediatr. Res."},{"key":"5120_CR5","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1542\/peds.2012-0541","volume":"129","author":"RA Polin","year":"2012","unstructured":"Polin, R. A. Committee on Fetus and Newborn Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 129, 1006\u20131015 (2012).","journal-title":"Pediatrics"},{"key":"5120_CR6","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1001\/jamapediatrics.2016.4678","volume":"171","author":"MW Kuzniewicz","year":"2017","unstructured":"Kuzniewicz, M. W. et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr. 171, 365\u2013371 (2017).","journal-title":"JAMA Pediatr."},{"key":"5120_CR7","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-1881","volume":"144","author":"KM Puopolo","year":"2019","unstructured":"Puopolo, K. M. et al. Management of infants at risk for group B streptococcal disease. Pediatrics 144, e20191881 (2019). Erratum in: Pediatrics 144, e20192350 (2019).","journal-title":"Pediatrics"},{"key":"5120_CR8","first-page":"1","volume":"59","author":"JR Verani","year":"2010","unstructured":"Verani, J. R., McGee, L., Schrag, S. J. & Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC) Prevention of perinatal group B streptococcal disease\u2013revised guidelines from CDC, 2010. MMWR Recomm. Rep. 59, 1\u201336 (2010).","journal-title":"MMWR Recomm. 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Impact of neonatal early-onset sepsis calculator on antibiotic use within two tertiary healthcare centers. J. Perinatol. 37, 394\u2013397 (2017).","journal-title":"J. Perinatol."},{"key":"5120_CR12","doi-asserted-by":"publisher","first-page":"3860","DOI":"10.3109\/14767058.2016.1149563","volume":"29","author":"M Kerste","year":"2016","unstructured":"Kerste, M. et al. Application of sepsis calculator in newborns with suspected infection. J. Matern. Fetal Neonatal Med. 29, 3860\u20133865 (2016).","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"5120_CR13","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00431-018-3113-2","volume":"177","author":"NB Achten","year":"2018","unstructured":"Achten, N. B. et al. Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis. Eur. J. Pediatr. 177, 741\u2013746 (2018).","journal-title":"Eur. J. 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Implementation of the neonatal sepsis calculator in an Australian tertiary perinatal centre. Neonatology 113, 379\u2013382 (2018).","journal-title":"Neonatology"},{"key":"5120_CR17","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1136\/archdischild-2018-316777","volume":"105","author":"N Goel","year":"2020","unstructured":"Goel, N. et al. Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population. Arch. Dis. Child. Fetal Neonatal Ed. 105, 118\u2013122 (2020).","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"5120_CR18","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.jpeds.2017.11.045","volume":"195","author":"D Carola","year":"2018","unstructured":"Carola, D. et al. Utility of early-onset sepsis risk calculator for neonates born to mothers with chorioamnionitis. J. Pediatr. 195, 48\u201352.e1 (2018).","journal-title":"J. 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