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A tool to help doctors identify newborns at risk for sepsis (a blood infection) may be used at BWH and other hospitals if Karen M. Puopolo, MD, PhD, has her way. Puopolo, a Newborn Medicine specialist, developed a tool that uses information from a mother’s electronic medical record (EMR) to generate a “risk score” that doctors can use when deciding whether a newborn should be tested for sepsis.
To Test or Not to Test
The decision to test a newborn for sepsis is sometimes unclear, since some infected infants do not have symptoms and appear healthy. Although there are guidelines to help doctors make this decision, they are unable to identify every infected baby. Also can result in unnecessary treatment of too many—most of whom are uninfected. Puopolo’s new tool can address this issue.
“Our model can identify the at-risk infants with greater accuracy and can spare many infants unnecessary evaluations and exposure to antibiotics,” said Puopolo.
Moreover, the tool can be directly embedded in an EMR. This unique feature gives health care providers immediate access, which can lead to more efficient decision-making and, if needed, testing and treatment.
Creating the Tool
Puopolo, her collaborator Gabriel J. Escobar, MD, Department of Pediatrics, Kaiser Permanente Medical Center, and their team designed the risk-assessment tool using information from a study they conducted and published in the November 2011 issue of Pediatrics. They identified 350 infants born at 34 or more weeks gestation with early-onset sepsis at BWH, Beth Israel Deaconess Medical Center and Kaiser Permanente Medical Care hospital system in California. They then compared the mothers’ EMRs with those of mothers with healthy babies.
They found that several factors can influence an infant’s sepsis risk, such as a mother’s body temperature, the length of time it takes for her water to break and if she had a late-preterm or post-term delivery. The study also noted that giving antibiotics during labor decreased sepsis risk. The new tool uses these factors when calculating a newborn’s risk score.
Sepsis can lead to severe developmental handicaps or death. However, with accurate risk-assessment tools and appropriate therapy, these outcomes can be prevented.
“Onset of illness can occur right at delivery, or the infant can look well right after delivery and only become ill later in the first day or so of life,” said Puopolo. “This is why the issue of evaluating asymptomatic babies [babies without symptoms] with risk factors is important. [We need] to identify them before they get very sick and offer prompt antibiotic treatment.”
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