Risk assessment at 35 weeks and over

OSCE stationVivaEarly-onset sepsis

A viva on the approaches to early-onset sepsis risk assessment in term and late-preterm babies.

Questions

1. What three approaches to risk assessment does the AAP describe?

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   • Categorical algorithms using threshold values for intrapartum risk factors.
   • Multivariate risk assessment based on intrapartum risk factors and infant examinations, for example the Neonatal Early-Onset Sepsis Risk Calculator.
   • Serial physical examination to detect clinical signs of illness.
   • The AAP describes each as a reasonable approach.

2. If the unit uses the calculator, what actions does the AAP recommend at which risk thresholds?

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   • Estimated risk of 1 per 1000 live births or more: blood culture and enhanced clinical observation.
   • Estimated risk of 3 per 1000 or more: blood culture and empirical antibiotics.

3. What did the prospective validation show?

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   • In 204 685 infants, blood culture testing fell by 66% and empirical antibiotic use by 48% compared with the previous categorical approach.
   • Readmissions for culture-confirmed infection in the week after discharge were rare (about 5 per 100 000 births) and didn't differ between approaches.

4. What condition does NICE attach to using the calculator in the UK?

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   • It can be used as an alternative to the NICE framework for babies born after 34+0 weeks in a neonatal unit, transitional care or postnatal ward.
   • It should only be used as part of a prospective audit recording the number assessed, correctly identified, incorrectly identified, and missed culture-confirmed infections.

Based on: American Academy of Pediatrics, Management of neonates born at ≥35 0/7 weeks' gestation with suspected or proven early-onset bacterial sepsis (Pediatrics, 2018); NICE guideline NG195, Neonatal infection: antibiotics for prevention and treatment (2021, last updated May 2026).