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

AimTo 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.MethodsA retrospective study of live-born infants with gestational age & GE; 37 + 0 weeks born after prolonged rupture of membranes (& GE;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.ResultsThe 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.ConclusionThe 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.

Automated summary

This study aimed to compare the patient trajectories of term infants with prolonged rupture of membranes as a risk factor for early-onset sepsis using biochemical surveillance or clinical observation. The results showed that hospitals using biochemical surveillance had more C-reactive protein measurements, neonatal intensive care unit admissions, and antibiotic treatment. However, there were no differences between the two methods in antibiotic treatment duration, early-onset sepsis cases, length of hospitalization, or adverse outcomes.