Biochemical surveillance versus clinical observation of term infants born after prolonged rupture of membranes - A quality assurance initiative.

Autor: Rød E; Faculty of Medicine, University of Oslo, Oslo, Norway., Solberg V; Faculty of Medicine, University of Oslo, Oslo, Norway., Stenersen EO; Faculty of Medicine, University of Oslo, Oslo, Norway.; Institute of clinical medicine, Faculty of Medicine, University of Oslo, Oslo, Norway., Garberg HT; Department of Paediatric and Adolescent Medicine, Drammen Hospital, Drammen, Norway., Mjelle AB; Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway., Tølløfsrud PA; Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway., Rønnestad AE; Institute of clinical medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.; Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway., Solevåg AL; Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
Jazyk: angličtina
Zdroj: Acta paediatrica (Oslo, Norway : 1992) [Acta Paediatr] 2023 Mar; Vol. 112 (3), pp. 391-397. Date of Electronic Publication: 2022 Dec 19.
DOI: 10.1111/apa.16617
Abstrakt: Aim: To examine whether biochemical surveillance vs clinical observation of term infants with prolonged rupture of membranes as a risk factor for early-onset sepsis is associated with differences in patient trajectories in maternity and neonatal intensive care units.
Methods: A retrospective study of live-born infants with gestational age ≥ 37 + 0 weeks born after prolonged rupture of membranes (≥24 h) in four Norwegian hospitals 2017-2019. Two hospitals used biochemical surveillance, and two used predominantly clinical observation to identify early-onset sepsis cases.
Results: The biochemical surveillance hospitals had more C-reactive protein measurements (p < 0.001), neonatal intensive care unit admissions (p < 0.001) and antibiotic treatment (p < 0.001). Hospitals using predominantly clinical observation initiated antibiotic treatment earlier in infants with suspected early-onset sepsis (p = 0.04) but not in infants fulfilling early-onset sepsis diagnostic criteria (p = 0.09). There was no difference in antibiotic treatment duration (p = 0.59), fraction of infants fulfilling early-onset sepsis diagnostic criteria (p = 0.49) or length of hospitalisation (p = 0.30), and no early-onset sepsis-related adverse outcomes.
Conclusion: The biochemical surveillance hospitals had more C-reactive protein measurements, but there was no difference in antibiotic treatment duration, early-onset sepsis cases, length of hospitalisation or adverse outcomes. Personnel resources needed for clinical surveillance should be weighed against the limitation of potentially painful procedures.
(© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)
Databáze: MEDLINE
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