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dc.contributor.authorAchten, Niek B.
dc.contributor.authorKlingenberg, Claus
dc.contributor.authorBenitz, William E.
dc.contributor.authorStocker, Martin
dc.contributor.authorSchlapbach, Luregn J.
dc.contributor.authorGiannoni, Eric
dc.contributor.authorBokelaar, Robin
dc.contributor.authorDriessen, Gertjan J.A.
dc.contributor.authorBrodin, Petter
dc.contributor.authorUthaya, Sabita
dc.contributor.authorvan Rossum, Annemarie M.C.
dc.contributor.authorPlötz, Frans B.
dc.date.accessioned2020-01-28T07:15:04Z
dc.date.available2020-01-28T07:15:04Z
dc.date.issued2019-09-03
dc.description.abstract<i>Importance</i> - The neonatal early-onset sepsis (EOS) calculator is a clinical risk stratification tool increasingly used to guide the use of empirical antibiotics for newborns. Evidence on the effectiveness and safety of the EOS calculator is essential to inform clinicians considering implementation.<p> <p><i>Objective</i> - To assess the association between management of neonatal EOS guided by the neonatal EOS calculator (compared with conventional management strategies) and reduction in antibiotic therapy for newborns.<p> <p><i>Data Sources</i> - Electronic searches in MEDLINE, Embase, Web of Science, and Google Scholar were conducted from 2011 (introduction of the EOS calculator model) through January 31, 2019.<p> <p><i>Study Selection</i> - All studies with original data that compared management guided by the EOS calculator with conventional management strategies for allocating antibiotic therapy to newborns suspected to have EOS were included.<p> <p><i>Data Extraction and Synthesis</i> - Following PRISMA-P guidelines, relevant data were extracted from full-text articles and supplements. CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) tools were used to assess the risk of bias and quality of evidence. Meta-analysis using a random-effects model was conducted for studies with separate cohorts for EOS calculator and conventional management strategies.<p> <p><i>Main Outcomes and Measures</i> - The difference in percentage of newborns treated with empirical antibiotics for suspected or proven EOS between management guided by the EOS calculator and conventional management strategies. Safety-related outcomes involved missed cases of EOS, readmissions, treatment delay, morbidity, and mortality.<p> <p><i>Results</i> - Thirteen relevant studies analyzing a total of 175 752 newborns were included. All studies found a substantially lower relative risk (range, 3%-60%) for empirical antibiotic therapy, favoring the EOS calculator. Meta-analysis revealed a relative risk of antibiotic use of 56% (95% CI, 53%-59%) in before-after studies including newborns regardless of exposure to chorioamnionitis. Evidence on safety was limited, but proportions of missed cases of EOS were comparable between management guided by the EOS calculator (5 of 18 [28%]) and conventional management strategies (8 of 28 [29%]) (pooled odds ratio, 0.96; 95% CI, 0.26-3.52; <i>P</i> = .95).<p> <p><i>Conclusions and Relevance</i> - Use of the neonatal EOS calculator is associated with a substantial reduction in the use of empirical antibiotics for suspected EOS. Available evidence regarding safety of the use of the EOS calculator is limited, but shows no indication of inferiority compared with conventional management strategies.en_US
dc.descriptionFinally version with altered title.en_US
dc.identifier.citationAchten, Klingenberg C, Benitz WE, Stocker M, Schlapbach LJ, Giannoni E, Bokelaar, Driessen, Brodin P, Uthaya, van Rossum, Plötz. Association of use of the neonatal early-onset sepsis calculator with reduction in antibiotic therapy and safety: A systematic review and meta-analysis. JAMA pediatrics. 2019:1-9en_US
dc.identifier.cristinIDFRIDAID 1743450
dc.identifier.doi10.1001/jamapediatrics.2019.2825
dc.identifier.issn2168-6203
dc.identifier.issn2168-6211
dc.identifier.urihttps://hdl.handle.net/10037/17236
dc.language.isoengen_US
dc.publisherAmerican Medical Associationen_US
dc.relation.journalJAMA pediatrics
dc.rights.accessRightsopenAccessen_US
dc.rights.holder© 2019 American Medical Association. All rights reserved.en_US
dc.subjectVDP::Medical disciplines: 700en_US
dc.subjectVDP::Medisinske Fag: 700en_US
dc.titleAssociation of use of the neonatal early-onset sepsis calculator with reduction in antibiotic therapy and safety: A systematic review and meta-analysisen_US
dc.type.versionacceptedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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