{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T14:52:03Z","timestamp":1746715923029,"version":"3.40.5"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                  <jats:p>Suspected early onset sepsis drives most antibiotic use in the newborn nursery. The Kaiser Sepsis Calculator (KSC) is a validated tool that safely decreases laboratory evaluation and antibiotic administration in infants aged \u226534 weeks. Our quality improvement aim was a nurse-initiated, KSC-based program to decrease blood cultures (BCx) and complete blood counts (CBC) by 10% from March 2021 to October 2021 among chorioamnionitis-exposed infants born \u226535 weeks\u2019 gestation. A secondary aim was to decrease antibiotic administration by 10%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>The KSC was implemented for infants at University Health, a county hospital affiliate of the University of Texas Health Science Center San Antonio, with a level I nursery and level IV NICU. The multidisciplinary project included pediatric hospitalists, neonatologists, family practitioners, maternal\u2013fetal medicine physicians, fellows, residents, and nurses. All infants born 6 months before (August 2020\u2013January 2021) and 7 months after protocol implementation (March 2021\u2013September 2021) were analyzed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>A total of 53 chorioamnionitis-exposed infants were included from the preintervention period and 51 from the postintervention period. CBC utilization decreased from 96% to 27%, BCx utilization decreased from 98% to 37%, and antibiotic utilization fell from 25% to 16%. In no cases were antibiotics prescribed against the KSC, and to our knowledge, no early onset sepsis diagnoses or infection-related hospital readmissions were missed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>The multidisciplinary implementation of the KSC led to a reduction in testing, exceeding our initial goal. A nurse-initiated protocol reduced BCx, CBC, and antibiotic utilization among chorioamnionitis-exposed infants.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/hpeds.2022-006554","type":"journal-article","created":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T08:05:58Z","timestamp":1671523558000},"page":"31-38","source":"Crossref","is-referenced-by-count":1,"title":["Quality Improvement Through Nurse-initiated Kaiser Sepsis Calculator at a County Hospital"],"prefix":"10.1542","volume":"13","author":[{"given":"Brandon R.","family":"Hadfield","sequence":"first","affiliation":[{"name":"aDivision of Neonatology, Departments of Pediatrics and"},{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Rowley","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz","family":"Puyol","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murtaza","family":"Ali","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara K.","family":"Neuhoff","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"},{"name":"cObstetrics and Gynecology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Lyman","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alma","family":"Saravia","sequence":"additional","affiliation":[{"name":"dDivision of Neonatology, Department of Pediatrics, University Health System, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandy","family":"Svatek","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Sherburne","sequence":"additional","affiliation":[{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph B.","family":"Cantey","sequence":"additional","affiliation":[{"name":"aDivision of Neonatology, Departments of Pediatrics and"},{"name":"bUniversity of Texas Health San Antonio, San Antonio, Texas"},{"name":"eDivision of Allergy, Immunology, and Infectious Diseases"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"issue":"12","key":"2023112713485092800_b1","doi-asserted-by":"crossref","first-page":"e1002984","DOI":"10.1371\/journal.pmed.1002984","article-title":"Incidence of maternal peripartum infection: a systematic review and meta-analysis. [Published online December 10, 2019]","volume":"16","author":"Woodd","year":"2019","journal-title":"PLoS Med"},{"issue":"1","key":"2023112713485092800_b2","doi-asserted-by":"crossref","first-page":"e20152323","DOI":"10.1542\/peds.2015-2323","article-title":"Chorioamnionitis and culture-confirmed, early-onset neonatal infections","volume":"137","author":"Wortham","year":"2016","journal-title":"Pediatrics"},{"issue":"8","key":"2023112713485092800_b3","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1515\/jpm-2017-0192","article-title":"Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis","volume":"46","author":"Randis","year":"2018","journal-title":"J Perinat Med"},{"issue":"10","key":"2023112713485092800_b4","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.3109\/14767058.2014.947578","article-title":"Perinatal antibiotic exposure of neonates in Canada and associated risk factors: a population-based study","volume":"28","author":"Persaud","year":"2015","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"6","key":"2023112713485092800_b5","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1111\/1471-0528.13601","article-title":"Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study","volume":"123","author":"Azad","year":"2016","journal-title":"BJOG"},{"issue":"7","key":"2023112713485092800_b6","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1111\/jpc.15384","article-title":"Cost savings from use of a neonatal sepsis calculator in Australia: a modeled economic analysis","volume":"57","author":"Cussen","year":"2021","journal-title":"J Paediatr Child Health"},{"issue":"10","key":"2023112713485092800_b7","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1038\/s41372-021-01154-y","article-title":"Impact of early-onset sepsis guidelines on breastfeeding","volume":"41","author":"Kasat","year":"2021","journal-title":"J Perinatol"},{"issue":"12","key":"2023112713485092800_b8","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1038\/jp.2017.137","article-title":"Anti-microbial stewardship: antibiotic use in well-appearing term neonates born to mothers with chorioamnionitis","volume":"37","author":"Money","year":"2017","journal-title":"J Perinatol"},{"issue":"5","key":"2023112713485092800_b9","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.siny.2017.07.001","article-title":"Antibiotic stewardship in perinatal and neonatal care","volume":"22","author":"Ramasethu","year":"2017","journal-title":"Semin Fetal Neonatal Med"},{"key":"2023112713485092800_b10","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jpeds.2018.09.024","article-title":"Screening and serial neutrophil counts do not contribute to the recognition or diagnosis of late-onset neonatal sepsis","volume":"205","author":"Rosenfeld","year":"2019","journal-title":"J Pediatr"},{"issue":"8","key":"2023112713485092800_b11","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1097\/INF.0b013e31825691e4","article-title":"Use of the complete blood cell count in late-onset neonatal sepsis","volume":"31","author":"Hornik","year":"2012","journal-title":"Pediatr Infect Dis J"},{"issue":"5","key":"2023112713485092800_b12","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1542\/peds.2010-0935","article-title":"Interpreting complete blood counts soon after birth in newborns at risk for sepsis","volume":"126","author":"Newman","year":"2010","journal-title":"Pediatrics"},{"issue":"3","key":"2023112713485092800_b13","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1001\/jamapediatrics.2019.5669","article-title":"Assessment of C-reactive protein diagnostic test accuracy for late-onset infection in newborn infants: a systematic review and meta-analysis","volume":"174","author":"Brown","year":"2020","journal-title":"JAMA Pediatr"},{"issue":"2","key":"2023112713485092800_b14","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.clp.2021.03.012","article-title":"Biomarkers for the diagnosis of neonatal sepsis","volume":"48","author":"Cantey","year":"2021","journal-title":"Clin Perinatol"},{"issue":"5","key":"2023112713485092800_b15","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/QCO.0000000000000764","article-title":"Neonatal bloodstream infections","volume":"34","author":"Hadfield","year":"2021","journal-title":"Curr Opin Infect Dis"},{"issue":"2","key":"2023112713485092800_b16","doi-asserted-by":"crossref","first-page":"e20191881","DOI":"10.1542\/peds.2019-1881","article-title":"Management of infants at risk for group B streptococcal disease","volume":"144","author":"Puopolo","year":"2019","journal-title":"Pediatrics"},{"issue":"6","key":"2023112713485092800_b17","doi-asserted-by":"crossref","first-page":"e20182894","DOI":"10.1542\/peds.2018-2894","article-title":"Management of neonates born at \u226535 0\/7 weeks\u2019 gestation with suspected or proven early-onset bacterial sepsis","volume":"142","author":"Puopolo","year":"2018","journal-title":"Pediatrics"},{"key":"2023112713485092800_b18","unstructured":"ABIM Foundation. Pediatric hospital medicine \u2013 SHM, AAP, APA. Available at: https:\/\/www.choosingwisely.org\/societies\/pediatric-hospital-medicine-shm-aap-apa\/. Accessed August 13, 2022"},{"issue":"5","key":"2023112713485092800_b19","doi-asserted-by":"crossref","first-page":"e1155","DOI":"10.1542\/peds.2010-3464","article-title":"Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors","volume":"128","author":"Puopolo","year":"2011","journal-title":"Pediatrics"},{"issue":"5","key":"2023112713485092800_b20","first-page":"232","article-title":"Development and implementation of an early-onset sepsis calculator to guide antibiotic management in late preterm and term neonates","volume":"42","author":"Kuzniewicz","year":"2016","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"4","key":"2023112713485092800_b21","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1001\/jamapediatrics.2016.4678","article-title":"A quantitative, risk-based approach to the management of neonatal early-onset sepsis","volume":"171","author":"Kuzniewicz","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"1","key":"2023112713485092800_b22","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1542\/peds.2013-1689","article-title":"Stratification of risk of early-onset sepsis in newborns \u226534 weeks\u2019 gestation","volume":"133","author":"Escobar","year":"2014","journal-title":"Pediatrics"},{"issue":"1","key":"2023112713485092800_b23","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/ANC.0000000000000668","article-title":"Implementation of the neonatal sepsis calculator in early-onset sepsis and maternal chorioamnionitis","volume":"20","author":"Akangire","year":"2020","journal-title":"Adv Neonatal Care"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/13\/1\/31\/1574447\/hpeds.2022-006554.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/13\/1\/31\/1574447\/hpeds.2022-006554.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T13:49:26Z","timestamp":1701092966000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/13\/1\/31\/190324\/Quality-Improvement-Through-Nurse-initiated-Kaiser"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,20]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,12,20]]},"published-print":{"date-parts":[[2023,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2022-006554","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"type":"print","value":"2154-1663"},{"type":"electronic","value":"2154-1671"}],"subject":[],"published":{"date-parts":[[2022,12,20]]}}}