Monthly rates of antibiotic administration. The monthly rate of empirical antibiotic administration was defined as the number of infants born at ≥36 0/7 weeks’ gestation who were administered antibiotics at ≤72 hours of age divided by the total number of infants born at ≥36 0/7weeks’ gestation per calendar month. The 6-week washout period is not included. Statistical process control using p-chart methodology is shown, with the upper and lower control limits having been determined by the pre-SRC period data. The criteria for significant change in process were met after SRC implementation, with >8 consecutive data points falling below the pre-SRC mean.
↵a Routine WBN newborn care during both study periods included vital signs every hour for 3 h after transfer to the WBN followed by vital signs every 4 h until 12 h of age and every 12 h thereafter. In both study periods, infants for whom antibiotics were initiated could be transferred to the WBN if they were well appearing after the first antibiotic doses were administered.
↵a The total population is 6085 infants, including 8 infants with missing risk estimates; 5 infants were born outside the hospital and ineligible for SRC use and are not included.
↵b One infant in the post-SRC period had a sepsis risk estimate at birth of 1.80 based on a maternal maximum temperature of 101°F. The obstetric team reported that a repeat measurement shortly thereafter was 98.8°F, yielding a risk estimate of 0.27 per 1000 LBs. Given obstetrical uncertainty about the validity of the brief temperature elevation and the good clinical appearance of the infant, the NICU team opted to provide enhanced clinical surveillance only.
Any EOS evaluation includes any combination of blood culture, CBC count with white blood cell differential, and/or CRP testing, excluding the CBC count in isolation. Relative risk is that of the procedure occurring in the post-SRC period compared with the pre-SRC period. All differences except for CBC count alone have P < .001. CBC/diff, complete blood cell count with white blood cell differential measurement.
↵a Five infants in the pre-SRC period had a CRP only, and 3 infants in the post-SRC period had a blood culture and CRP testing (CBC count clotted in each case and was not repeated in 72 h).