{
  "abstract": "Objectives While antibiotics save lives in infants with sepsis, up to 12.0% of non-infected term and late preterm infants are exposed to antibiotics underscoring diagnostic challenges in early onset sepsis (EOS).This study aimed to assess whether serial physical examination (SPE) in neonatal intensive care units (NICUs) could safely reduce early antibiotic exposure in infants born at ≥34 weeks’ gestation at risk for EOS.Design A population-based, multicentre interventional study from 2018 throughout 2021.Setting Six Norwegian tertiary and secondary level NICUs.Patients In total, 54 713 liveborn infants were eligible for inclusion.Interventions Infants at risk for EOS (mild/transient clinical signs, chorioamnionitis-exposed or group B streptococcus sepsis in a sibling) were clinically monitored with SPE for 24–48 hours. Infants with no/transient clinical signs did not receive antibiotics, whereas treatment was initiated without delay if signs indicated severe EOS, clinical condition deteriorated despite intervention or vital signs failed to improve.Main outcome measures Comparative statistics were used to evaluate changes after implementing SPE, including percentage of infants exposed to antibiotics, incidence of EOS, NICU and safety outcomes (time from birth to antibiotics administration in EOS, infection-related deaths and re-admissions for infection). A statistical process control chart was used to evaluate antibiotic exposure over time.Results Infants exposed to antibiotics were reduced by 50%, from 1.8% (95% CI 1.6% to 2.0%) to 0.9% (95% CI 0.8% to 1.1%).Incidence of culture-positive EOS, NICU admission rates and safety outcomes remained unchanged.Conclusion SPE reduced antibiotic exposure in infants ≥34 weeks’ gestation without compromising safety.",
  "authors": [
    {
      "affiliations": [
        "Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway"
      ],
      "name": "Anlaug Vatne"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Møre og Romsdal Hospital Trust, Alesund, Norway",
        "Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway"
      ],
      "name": "Beate Horsberg Horsberg Eriksen"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Førde Hospital Trust, Førde, Sogn og Fjordane, Norway"
      ],
      "name": "Fabian Bergqvist"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Nordlandssykehuset Bodø, Bodø, Nordland, Norway"
      ],
      "name": "Ingebjørg Fagerli"
    },
    {
      "affiliations": [
        "Department of Paediatrics and Adolescents Medicine, Haukeland Universitetssjukehus, Bergen, Norway"
      ],
      "name": "Hans Jørgen Timm Guthe"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Sørlandet Sykehus HF, Kristiansand, Vest-Agder, Norway"
      ],
      "name": "Kristin Vabo Iversen"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Møre og Romsdal Hospital Trust, Alesund, Norway"
      ],
      "name": "Farhan Saleem Ud Din"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Fonna Hospital Haugesund",
        "Haugesund, Norway, Haugesund sjukehus, Haugesund, Rogaland, Norway"
      ],
      "name": "Joyce van der Weijde"
    },
    {
      "affiliations": [
        "Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway",
        "Department of Research, Stavanger University Hospital, Stavanger, Norway"
      ],
      "name": "Jan Terje Kvaløy"
    },
    {
      "affiliations": [
        "Department of Simulation-based learning, Stavanger University Hospital, Stavanger, Norway",
        "Faculty of Health Sciences, University of Stavanger, Stavanger, Norway"
      ],
      "name": "Siren Rettedal"
    }
  ],
  "title": "Serial physical examination to reduce unnecessary antibiotic exposure in newborn infants: a population-based study",
  "uid": "40703f25-080d-5877-84a6-603db19b49a5"
}