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Am J Perinatol 2022; 39(10): 1117-1123
DOI: 10.1055/s-0040-1721691
Original Article

Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey

Ligia Maria Suppo de Souza Rugolo
1   Division of Neonatology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista–UNESP, Botucatu, Brazil
,
Maria Regina Bentlin 
1   Division of Neonatology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista–UNESP, Botucatu, Brazil
,
Maria Fernanda Branco de Almeida
2   Division of Neonatal Medicine, Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, Brazil
,
Ruth Guinsburg
2   Division of Neonatal Medicine, Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, Brazil
,
Werther Brunow de Carvalho
3   Department of Pediatrics, University of São Paulo, School of Medicine, São Paulo, Brazil
,
Sergio Tadeu Martins Marba
4   Department of Pediatrics, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Brazil
,
João Henrique Carvalho Leme de Almeida
5   Division of Neonatology, Instituto Nacional de Saúde da Criança, Mulher e Adolescente Fernandes Figueira–Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Jorge Hecker Luz
6   Department of Pediatrics, Hospital São Lucas–Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
,
Renato Soibelmann Procianoy 
7   Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre -HCPA, Porto Alegre, Brazil
,
José Luiz Muniz Bandeira Duarte
8   Department of Pediatrics, Hospital Universitário Pedro Ernesto–Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil
,
Leni Márcia Anchieta
9   Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
,
Daniela Marques de Lima Mota Ferreira
10   Department of Pediatrics, Universidade Federal de Uberlândia, Uberlândia, Brazil
,
José Mariano Sales Alves Júnior
11   Department of Pediatrics, Maternidade Hilda Brandão–Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
,
Edna Maria de Albuquerque Diniz
12   Division of Neonatology, University of São Paulo, Brazil da Universidade de São Paulo, Hospital Universitário, São Paulo, Brazil
,
Juliana Paula Ferraz dos Santos
13   Division of Neonatal, Hospital Estadual Sumaré, Sumaré, Brazil
,
Carolina Boschi Gimenes
14   Neonatal Unit, Hospital Geral de Pirajussara, Taboão da Serra, Brazil
,
Nathalia Moura de Mello e Silva
15   Neonatal Unit, Hospital Estadual de Diadema, Diadema, Brazil
,
Lígia Lopes Ferrari
16   Department of Pediatrics, Hospital Universitário–Universidade Estadual de Londrina, Londrina, Brazil
,
Regina Paula Guimarães Vieira Cavalcante da Silva
17   Department of Pediatrics, Hospital de Clínicas–Universidade Federal do Paraná, Curitiba, Brazil
,
Jucille Meneses
18   Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
,
Walusa Assad Gonçalves-Ferri 
19   Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
,
Marynéa Silva do Vale
20   Department of Pediatrics, Universidade Federal do Maranhão, São Luís, Brazil
,
Holly Brine
21   Departent of Pediatrics, Promedica Toledo Children's Hospital, University of Toledo, Ohio
,
Gary M. Weiner
22   Department of Pediatrics, Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, Michigan
,
Brazilian Network on Neonatal Research › Author Affiliations
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Abstract

Objective Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions.

Study Design Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients.

Results In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions.

Conclusion Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS.

Key Points

  • Neonatologists overestimate the risk of EOS.

  • There is wide variation in diagnostic/treatment thresholds for EOS.

  • Clinical decision on EOS is not consistent with risk thresholds.

  • Knowledge of risk may increase investigation and treatment of EOS.

Keywords

neonatal sepsis - surveys - laboratory investigation - treatment


Publication History

Received: 20 May 2020

Accepted: 02 November 2020

Article published online:
20 December 2020

© 2020. Thieme. All rights reserved.

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