ALGORITHM FOR EOS

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Well Baby & Well Mother but Risk Factors Presents�

• Any of following

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• Preterm labor – prior to 37 weeks.
• Preterm rapture of membranes- prior to 37 weeks.
• Maternal Pyrexia in labour ->38C on one reading.
• Prolonged rapture of membrane >18 hours.
• Maternal Bacteriuria during current pregnancy.
• Maternal high vaginal swab positivity during the current pregnancy.
• Previous pregnancy complicated by neonatal sepsis.

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• Adequate Prophylaxis Given or Not
• Prophylaxis is adequate if the first dose is completed >4 hrs before delivery and continued at the correct intervals.
• Adequate Prophylaxis Given
• No Intervention needed
• Monitor for 24 hours for any clinical signs
• Adequate Prophylaxis Not Given
• Send CBC & CRP & Monitor for clinical signs of sepsis
• If normal or no signs- repeat CRP after 24 hours
• If still ok – Discharge
• Any concerns in Labs or Examination at any time –admit in NICU, do CXR, Blood CS and start IV antibiotics (cefotaxime).

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https://www.nice.org.uk/guidance/ng195/chapter/Recommendations

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Kaiser Newborn Sepsis:

• Interactive online tool based on a validated prediction rule to calculate the probability of EOS in infants greater than or equal to 34wks GA using specified maternal risk factors and the infant's clinical status.
• Calculator provides a basic clinical recommendation for management based on calculated risk.

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Probability of Neonatal Early Onset Based on Maternal Risk Factors and the Infant’s Clinical Presentation. https://neonatalsepsiscalculator.kaiserpermanente.org

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• Clarifying notes for use of Kaiser Sepsis Calculator:
• Criteria for screening:
• Risk factors for EOS:
• Gestational age <37wks
• Prolonged ROM (greater than or equal to 18 hours)
• Maternal fever or chorioamnionitis
• Maternal GBS+
• Need for resuscitation / signs of clinical illness at birth
• Consider for vital sign or clinical exam abnormalities in the first 12 hours after birth.

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• Neonatal Sepsis Diagnostic (NeoSed) score.
• Gestational age, CRP, considerable skin discoloration, liver enlargement, neutrophil left shift were identified as the strongest predictors and included in the Neonatal Sepsis Diagnostic (NeoSeD) model.

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• The Tollner score.
• The Töllner score is a clinical and hematological scoring system developed to aid in the early diagnosis of neonatal sepsis. It is based on a combination of clinical findings and laboratory results to assess the likelihood of sepsis. The score considers factors like skin coloration, respiratory distress, and hematological parameters. 

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Sokou R, Ioakeimidis G, Piovani D, Parastatidou S, Konstantinidi A, Tsantes AG, Lampridou M, Houhoula D, Iacovidou N, Kokoris S, Vaiopoulos AG, Gialeraki A, Kopterides P, Bonovas S, Tsantes AE. Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis. Front Pediatr. 2022 Oct 6;10:1004727. doi: 10.3389/fped.2022.1004727. PMID: 36275071; PMCID: PMC9582514.