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Achten NB, Plötz FB, Klingenberg C, Stocker M, Bokelaar R, Bijlsma M, Giannoni E, van Rossum AMC, Benitz WE. Stratification of Culture-Proven Early-Onset Sepsis Cases by the Neonatal Early-Onset Sepsis Calculator: An Individual Patient Data Meta-Analysis. J Pediatr. 2021 Feb 2:S0022-3476(21)00099-8. doi: 10.1016/j.jpeds.2021.01.065. Epub ahead of print. PMID: 33545190.

Objectives: To provide a comprehensive assessment of case stratification by the Neonatal Early-Onset Sepsis (EOS) Calculator, a novel tool for reducing unnecessary antibiotic treatment.

Study design: A systematic review with individual patient data meta-analysis was conducted, extending PROSPERO record CRD42018116188. Cochrane, PubMed/MEDLINE, EMBASE, Web of Science, Google Scholar, and major conference proceedings were searched from 2011 through May 1, 2020. Original data studies including culture-proven EOS case(s) with EOS Calculator application, independent from EOS Calculator development, and including representative birth cohorts were included. Relevant (individual patient) data were extracted from full-text and data queries. Main outcomes were the proportions of EOS cases assigned to risk categories by the EOS Calculator at initial assessment and within 12 hours. Evidence quality was assessed using Newcastle-Ottawa scale, CHARMS and GRADE tools.

Results: Among 543 unique search results, 18 were included, totalling over 459000 newborns. Among 234 EOS cases, EOS Calculator application resulted in initial assignments to (strong consideration of) empiric antibiotic administration for 95 (40.6%; 95% confidence interval 34.2-47.2%), more frequent vital signs for 36 (15.4%; 11.0-20.7%), and routine care for 103 (44.0%; 37.6-50.6%). By 12 hours of age, these proportions changed to 143 (61.1%; 54.5-67.4%), 26 (11.1%; 7.4-15.9%), and 65 (27.8%; 22.1-34.0%) of 234 EOS cases, respectively.

Conclusions: EOS Calculator application assigns frequent vital signs or routine care to a substantial proportion of EOS cases. Clinical vigilance remains essential for all newborns.

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