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

• Published in: Acta Paediatrica Vol. 112; no. 3; pp. 391 - 397
• Main Authors: Rød, Emma, Solberg, Vilde, Stenersen, Eydís Oddsdóttir, Garberg, Håvard Tetlie, Mjelle, Anders Batman, Tølløfsrud, Per Arne, Rønnestad, Arild Erland, Solevåg, Anne Lee
• Format: Journal Article
• Language: English
• Published: Norway Wiley Subscription Services, Inc 01-03-2023; John Wiley and Sons Inc
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; C-Reactive Protein; early‐onset sepsis; Female; Fetal Membranes, Premature Rupture - chemically induced; Fetal Membranes, Premature Rupture - drug therapy; Gestational age; Hospitals; Humans; Infant; Infant, Newborn; Infants; Intensive care; Intensive care units; Neonates; Original; Original & Brief Reports; Parturition; Pregnancy; prolonged rupture of membranes; Quality assurance; Retrospective Studies; Risk factors; Rupture; Sepsis; Sepsis - diagnosis; Sepsis - epidemiology; Surveillance; term infant; prolonged rupture of membranes; early-onset sepsis; C-reactive protein; term infant; antibiotics
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/apa.16617

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.