Introduction: Early-onset neonatal sepsis (EONS) remains a serious problem in preterm infants. Previous guidelines at Chiang Mai University, all preterm infants with risk of EONS required empirical antibiotics. New guideline was revised in 2019 based on the latest AAP recommendations. Asymptomatic late preterm infants with risk of EONS can be closely monitored and not need empirical antibiotics.
Objectives: To determine the efficacy and safety of 2019 CMU guidelines for management of asymptomatic late preterm infants at risk of EONS compared with previous guidelines.
Methods: A cross-sectional, retrospective study was done by reviewing medical records of asymptomatic infants born at 34 weeks’ to 36 weeks 6 days’ gestation with risk of EONS in CMU hospital during January 1, 2015 to December 31, 2020.
Results: A total of 167 asymptomatic late preterm infants were assigned to 2019 guideline group (n=93) and 2014 guideline group (n=74). Rate of empirical antibiotics used was significantly decreased from 100% in previous guidelines to 12.6 % in the 2019 guideline (p<0.001). Median length of stay declined from 6 (4-9) days to 5 (3-6) days (p 0.002) and cost of stay decreased from 15,214 (10885.5-20451.25) THB to 9,699 (7094.5-15341.5) THB (p 0.002), respectively. There were no significant differences in incidence of proven sepsis, late-onset sepsis (LONS) and readmission rates.
Conclusion: The CMU 2019 guideline had favorable profile in reduction of antibiotic use in asymptomatic late preterm newborns at risk of EONS without raising rate of proven sepsis, LONS and readmission within 1 month compared with the previous guideline.
Keywords: early-onset sepsis, late preterm, Thailand
