84: Empiric Neonatal Antibiotics for Maternal Fever: CRP as a Quality Improvement Intervention
Notice bibliographique
Résumé
Clinically suspected chorioamnionitis (CSC) is a commonly diagnosed complication of pregnancy. The burden of this diagnosis continues to impact maternal and neonatal care. To determine the usefulness of a single C-reactive protein (CRP) measurement in identifying when antibiotic treatment can be discontinued in asymptomatic neonates ≥35 weeks, investigated for early onset neonatal sepsis (EONS) secondary to CSC. As part of a quality improvement (QI) project to keep asymptomatic babies with their mothers, a clinical care map was developed focusing on reducing the intensity and duration of monitoring, investigating and treating those born to mothers with CSC. These at-risk newborns had routine diagnostic testing at birth and were monitored at their mothers' bedside where they received empiric intravenous antibiotic therapy. Antibiotic duration was reassessed based on the 24 h clinical exam and a CRP measurement obtained between 15 h and 22 h of age. Infants who remained well with CRP values less than 10 mg/L could have their antibiotics discontinued prior to the 48 h culture results and potentially be discharged home with parental counseling. A retrospective chart review was conducted between November 1, 2011 and November 1, 2012, on infants' ≥35 weeks gestation who were evaluated for EONS secondary to CSC. Data were abstracted for both maternal and infant diagnostic evaluations and clinical signs and symptoms. Of 5886 babies delivered during this period, 162 initially asymptomatic infants were investigated after birth for EONS secondary to CSC. Although none of the neonates had positive blood cultures, 10 went onto develop symptoms consistent with EONS. Despite three of the symptomatic infants having low CRP levels, all 10 received antibiotics in NICU for between 48 h to seven days. Of the remaining 152 asymptomatic infants, 125 had CRP values <10 mg/L and 113 (90%) of those neonates had <48 h of antibiotics. Forty-nine infants were discharged home before two days. The 27 asymptomatic infants with high CRP measurements remained in postpartum and were treated until the 48 h blood culture results were reported as negative. For asymptomatic at-risk neonates, a CRP measurement <10 mg/L between 15 h and 22 h of age supported clinical assessment and reduce both antibiotic exposure and length of hospital stay. The clinical care map optimizes the allocation of neonatal resources, supports a family centered approach to practice and is clinically safe.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».