CC BY-NC-ND 4.0 · Am J Perinatol
DOI: 10.1055/a-2202-3830
Original Article

Utility of the Neonatal Early-Onset Sepsis Calculator in a Low-Risk Population

Kelley M. Sonney
1   Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
Dakota Tomasini
1   Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
James K. Aden
1   Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
2   Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
› Author Affiliations
Funding None.


Objective To compare early-onset sepsis (EOS) risk estimation and recommendations for infectious evaluation and/or empiric antibiotics using a categorical risk assessment versus the Neonatal Early-Onset Sepsis Calculator in a low-risk population.

Study Design Retrospective chart review of late preterm (≥350/7–366/7 weeks' gestational age) and term infants born at the Brooke Army Medical Center between January 1, 2012 and August 29, 2019. We evaluated those born via cesarean section with rupture of membranes (ROM) < 10 minutes. Statistical analysis was performed to compare recommendations from a categorical risk assessment versus the calculator.

Results We identified 1,187 infants who met inclusion criteria. A blood culture was obtained within 72 hours after birth from 234 (19.7%) infants and 170 (14.3%) received antibiotics per routine clinical practice, using categorical risk assessment. Respiratory distress was the most common indication for evaluation, occurring in 173 (14.6%) of patients. After applying the Neonatal Early-Onset Sepsis Calculator to this population, the recommendation was to obtain a blood culture on 166 (14%), to start or strongly consider starting empiric antibiotics on 164 (13.8%), and no culture or antibiotics on 1,021 (86%). Utilizing calculator recommendations would have led to a reduction in frequency of blood culture (19.7 vs. 14%, p < 0.0001) but no reduction in empiric antibiotics (14.3 vs. 13.8%, p = 0.53). There were no cases of culture-proven EOS.

Conclusion This population is low risk for development of EOS; however, 19.7% received an evaluation for infection and 14.3% received antibiotics. Utilization of the Neonatal Early-Onset Sepsis Risk Calculator would have led to a significant reduction in the evaluation for EOS but no reduction in antibiotic exposure. Consideration of delivery mode and indication for delivery may be beneficial to include in risk assessments for EOS.

Key Points

  • Cesarean section with rupture of membranes at delivery confers low risk for EOS.

  • Respiratory distress often triggers an EOS evaluation.

  • Delivery mode should be considered in EOS risk.

Publication History

Received: 31 July 2023

Accepted: 30 October 2023

Accepted Manuscript online:
01 November 2023

Article published online:
04 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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