{
  "abstract": "Anlaug Vatne and colleagues report the outcome of a multicentre interventional study from six Norwegian tertiary and secondary level NICUS to assess whether serial physical examination (SPE) in neonatal intensive care units could safely reduce early antibiotic exposure in infants born at≥34 weeks’ gestation at risk for early onset sepsis (EOS). The study took place from 2018 to 2021 and included a birth population of>54 000 liveborn infants. Infants with risk factors for early onset sepsis or with mild clinical signs were admitted to the NICU and underwent serial physical examinations by the nursing staff for 24–48 hours, without antibiotic treatment. If infants deteriorated or did not improve antibiotics were commenced. Around 10% of eligible infants were admitted to the NICU and 0.9% of infants received intravenous antibiotics. The incidence of culture positive early onset sepsis was 0.55 per 1000 live births. There were no infection related mortalities or readmissions to the NICU with sepsis. This is the largest study to date evaluating clinical observation in favour of empirical treatment of infants with risk factors and is in marked contrast with the levels of antibiotic exposure in settings where treatment on the basis of risk factors is preferred. In an accompanying editorial, Sujoy Bannerjee compares and contrasts the effects of the three different current approaches to prevention and treatment of early onset sepsis that are in use - categorical univariate risk assessment guidelines such as those from the UK National Institute for Health and Care Excellence (NICE) and US Centres for Disease Control (CDC); the Kaiser Permanente Sepsis Risk Calculator (SRC); and the serial physical examination (SPE) model. With further enhancement to keep mums and babies together for the period of observation that are now being studied by Vatne and colleagues the SPE approach will likely become even more compelling.",
  "authors": [
    {
      "affiliations": [
        "Consultant Neonatologist, Simpson Centre for Reproductive Health, Edinburgh, Edinburgh, UK"
      ],
      "name": "Ben J Stenson"
    }
  ],
  "title": "Fantoms",
  "uid": "5eab75c1-3d37-50d4-b4f5-abdeb927e7e1"
}