Clinical and economic impacts of a modified-observational screening approach to well-appearing infants born to mothers with chorioamnionitis.
Journal
Journal of perinatology : official journal of the California Perinatal Association
ISSN: 1476-5543
Titre abrégé: J Perinatol
Pays: United States
ID NLM: 8501884
Informations de publication
Date de publication:
28 Dec 2023
28 Dec 2023
Historique:
received:
07
09
2023
accepted:
12
12
2023
revised:
14
11
2023
medline:
29
12
2023
pubmed:
29
12
2023
entrez:
28
12
2023
Statut:
aheadofprint
Résumé
Term infants born to mothers with chorioamnionitis are at risk for early-onset sepsis (EOS). We aimed to measure the impact of changing from a categorical to a modified-observational EOS screening approach on NICU admission, antibiotic utilization, and hospitalization costs. Single-center retrospective pre-post cohort study of full-term infants born to mothers with chorioamnionitis. Primary outcomes included NICU admission, antibiotic utilization, and hospitalization costs. Outcomes were adjusted for demographic variables. Budget-impact analysis was performed using bootstrapping with replication. 380 term infants were included (197 categorical; 183 modified-observational). There was a significant decrease in NICU admission and antibiotic utilization (p < 0.05) in the modified-observational cohort but no significant difference in per-patient total hospitalization costs. Budget-impact analysis suggested a high probability of cost savings. A modified-observational approach to evaluating term infants of mothers with chorioamnionitis can reduce NICU admission and unnecessary antibiotic therapy, and may lead to cost-savings.
Identifiants
pubmed: 38155229
doi: 10.1038/s41372-023-01858-3
pii: 10.1038/s41372-023-01858-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.
Références
Briggs-Steinberg C, Roth P. Early-onset sepsis in newborns. Pediatr Rev. 2023;44:14–22. https://doi.org/10.1542/pir.2020-001164 .
doi: 10.1542/pir.2020-001164
pubmed: 36587021
Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. J Pediatr. 2015;166:1070–4. https://doi.org/10.1016/j.jpeds.2014.12.023 .
doi: 10.1016/j.jpeds.2014.12.023
pubmed: 25641240
pmcid: 4767008
Puopolo KM, Lynfield R, Cummings JJ. Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of infants at risk for Group B streptococcal disease [published correction appears in Pediatrics. 2019 Oct;144:]. Pediatrics. 2019;144:e20191881. https://doi.org/10.1542/peds.2019-1881 .
doi: 10.1542/peds.2019-1881
pubmed: 31285392
Puopolo KM, Benitz WE, Zaoutis TE. Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of neonates born at ≥35 0/7 weeks’ gestation with suspected or proven early-onset bacterial sepsis. Pediatrics. 2018;142:e20182894 https://doi.org/10.1542/peds.2018-2894 .
doi: 10.1542/peds.2018-2894
pubmed: 30455342
Risnes KR, Belanger K, Murk W, Bracken MB. Antibiotic exposure by 6 months and asthma and allergy at 6 years: Findings in a cohort of 1,401 US children. Am J Epidemiol. 2011;173:310–8. https://doi.org/10.1093/aje/kwq400 .
doi: 10.1093/aje/kwq400
pubmed: 21190986
Saari A, Virta LJ, Sankilampi U, Dunkel L, Saxen H. Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life. Pediatrics. 2015;135:617–26. https://doi.org/10.1542/peds.2014-3407 .
doi: 10.1542/peds.2014-3407
pubmed: 25825533
Trasande L, Blustein J, Liu M, Corwin E, Cox LM, Blaser MJ. Infant antibiotic exposures and early-life body mass. Int J Obes. 2013;37:16–23. https://doi.org/10.1038/ijo.2012.132 .
doi: 10.1038/ijo.2012.132
Verani JR, McGee L, Schrag SJ. 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-revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59:1–36. (RR-10)
pubmed: 21088663
Wortham JM, Hansen NI, Schrag SJ, Hale E, Van Meurs K, Sanchez PJ, et al. Chorioamnionitis and culture-confirmed, early-onset neonatal infections. Pediatrics. 2016;137:e20152323. https://doi.org/10.1542/peds.2015-2323 .
doi: 10.1542/peds.2015-2323
pubmed: 26719293
pmcid: 4702021
Dhudasia MB, Benitz WE, Flannery DD, Christ L, Rub D, Remaschi G, et al. Diagnostic performance and patient outcomes with C-reactive protein use in early-onset sepsis evaluations. J Pediatr. 2023;256:98–104.e6. https://doi.org/10.1016/j.jpeds.2022.12.007 .
doi: 10.1016/j.jpeds.2022.12.007
pubmed: 36529283
Berardi A, Fornaciari S, Rossi C, Patianna V, Bacchi Reggiani ML, Ferrari F, et al. Safety of physical examination alone for managing well-appearing neonates ≥ 35 weeks’ gestation at risk for early-onset sepsis. J Matern Fetal Neonatal Med. 2015;28:1123–7. https://doi.org/10.3109/14767058.2014.946499 .
doi: 10.3109/14767058.2014.946499
pubmed: 25034325
Flidel-Rimon O, Galstyan S, Juster-Reicher A, Rozin I, Shinwell ES. Limitations of the risk factor based approach in early neonatal sepsis evaluations [published correction appears in Acta Paediatr. 2013 Aug;102(8):840]. Acta Paediatr. 2012;101:e540–e544. https://doi.org/10.1111/apa.12013 .
doi: 10.1111/apa.12013
pubmed: 22937988
Joshi NS, Gupta A, Allan JM, Cohen RS, Aby JL, Weldon B, et al. Clinical monitoring of well-appearing infants born to mothers with chorioamnionitis. Pediatrics. 2018;141:e20172056. https://doi.org/10.1542/peds.2017-2056 .
doi: 10.1542/peds.2017-2056
pubmed: 29599112
Achten NB, Klingenberg C, Benitz WE, Stocker M, Schlapbach LJ, Giannoni E, et al. Association of use of the neonatal early-onset sepsis calculator with reduction in antibiotic therapy and safety: a systematic review and meta-analysis. JAMA Pediatr. 2019;173:1032–40. https://doi.org/10.1001/jamapediatrics.2019.2825 .
doi: 10.1001/jamapediatrics.2019.2825
pubmed: 31479103
pmcid: 6724419
Dhudasia MB, Mukhopadhyay S, Puopolo KM. Implementation of the sepsis risk calculator at an academic birth hospital. Hosp Pediatr. 2018;8:243–50. https://doi.org/10.1542/hpeds.2017-0180 .
doi: 10.1542/hpeds.2017-0180
pubmed: 29666161
Achten NB, Dorigo-Zetsma JW, van der Linden PD, van Brakel M, Plötz FB. Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis. Eur J Pediatr. 2018;177:741–6. https://doi.org/10.1007/s00431-018-3113-2 .
doi: 10.1007/s00431-018-3113-2
pubmed: 29455368
Beavers JB, Bai S, Perry J, Simpson J, Peeples S. Implementation and evaluation of the early-onset sepsis risk calculator in a high-risk university nursery. Clin Pediatr. 2018;57:1080–5. https://doi.org/10.1177/0009922817751337 .
doi: 10.1177/0009922817751337
Gievers LL, Sedler J, Phillipi CA, Dukhovny D, Geddes J, Graven P, et al. Implementation of the sepsis risk score for chorioamnionitis-exposed newborns. J Perinatol. 2018;38:1581–7. https://doi.org/10.1038/s41372-018-0207-7 .
doi: 10.1038/s41372-018-0207-7
pubmed: 30158677
Kuzniewicz MW, Puopolo KM, Fischer A, Walsh EM, Li S, Newman TB, et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr. 2017;171:365–71. https://doi.org/10.1001/jamapediatrics.2016.4678 .
doi: 10.1001/jamapediatrics.2016.4678
pubmed: 28241253
Mauskopf JA, Paul JE, Grant DM, Stergachis A. The role of cost-consequence analysis in healthcare decision-making. Pharmacoeconomics. 1998;13:277–88. https://doi.org/10.2165/00019053-199813030-00002 .
doi: 10.2165/00019053-199813030-00002
pubmed: 10178653
How to use the searchable medicare physician fee schedule (MPFS): Centers for Medicare and Medicaid Services (CMS); 2017. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/index.html .
Dunn A, Grosse SD, Zuvekas SH. Adjusting health expenditures for inflation: a review of measures for health services research in the United States. Health Serv Res. 2018;53:175–96. https://doi.org/10.1111/1475-6773.12612 .
doi: 10.1111/1475-6773.12612
pubmed: 27873305
Fenwick E, Marshall DA, Levy AR, Nichol G. Using and interpreting cost-effectiveness acceptability curves: an example using data from a trial of management strategies for atrial fibrillation. BMC Health Serv Res. 2006;6:52. https://doi.org/10.1186/1472-6963-6-52 .
doi: 10.1186/1472-6963-6-52
pubmed: 16623946
pmcid: 1538588
Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BJOG. 2022;129:336–44. https://doi.org/10.1111/1471-0528.17012 .
doi: 10.1111/1471-0528.17012
pubmed: 35014160
Mihaylova B, Briggs A, O’Hagan A, Thompson SG. Review of statistical methods for analysing healthcare resources and costs. Health Econ. 2011;20:897–916. https://doi.org/10.1002/hec.1653 .
doi: 10.1002/hec.1653
pubmed: 20799344
Rallis D, Balomenou F, Karantanou K, Kappatou K, Tzoufi M, Giapros V. A comparison between risk-factor guidance for neonatal early-onset sepsis and Kaiser Permanente sepsis risk calculator in a Greek cohort. Early Hum Dev. 2021;155:105331. https://doi.org/10.1016/j.earlhumdev.2021.105331 .
doi: 10.1016/j.earlhumdev.2021.105331
pubmed: 33607601
Sloane AJ, Carola DL, Lafferty MA, Edwards C, Greenspan J, Aghai ZH. Management of infants born to mothers with chorioamnionitis: a retrospective comparison of the three approaches recommended by the committee on fetus and newborn. J Neonatal Perinat Med. 2021;14:383–90. https://doi.org/10.3233/NPM-200531 .
doi: 10.3233/NPM-200531
Pettinger KJ, Mayers K, McKechnie L, Phillips B. Sensitivity of the Kaiser Permanente early-onset sepsis calculator: a systematic review and meta-analysis. EClinicalMedicine. 2019;19:100227. https://doi.org/10.1016/j.eclinm.2019.11.020 . Published 2019 Dec 22
doi: 10.1016/j.eclinm.2019.11.020
pubmed: 32140666
pmcid: 7046522
Benincasa BC, Silveira RC, Schlatter RP, Balbinotto Neto G, Procianoy RS. Multivariate risk and clinical signs evaluations for early-onset sepsis on late preterm and term newborns and their economic impact. Eur J Pediatr. 2020;179:1859–65. https://doi.org/10.1007/s00431-020-03727-z .
doi: 10.1007/s00431-020-03727-z
pubmed: 32623627
Achten NB, Visser DH, Tromp E, Groot W, van Goudoever JB, Plötz FB. Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns. Eur J Pediatr. 2020;179:727–34. https://doi.org/10.1007/s00431-019-03510-9 .
doi: 10.1007/s00431-019-03510-9
pubmed: 31897840
pmcid: 7160215
Gong CL, Dasgupta-Tsinikas S, Zangwill KM, Bolaris M, Hay JW. Early onset sepsis calculator-based management of newborns exposed to maternal intrapartum fever: a cost benefit analysis. J Perinatol. 2019;39:571–80. https://doi.org/10.1038/s41372-019-0316-y .
doi: 10.1038/s41372-019-0316-y
pubmed: 30692615