Table 5.
Characteristics, management, and infant outcomes during period with and without routine CRP use in EOS
| Period 1 N = 4,977 | Period 2 N = 5,135 | P value | |
|---|---|---|---|
| Demographics and delivery characteristics | |||
| Maternal age, y | 29 (23, 33) | 31 (26, 34) | <0.001 |
| Race/ethnicity | <0.001 | ||
| White/Non-Hispanic | 1,555 (31.2) | 1,786 (34.8) | |
| Black/Non-Hispanic | 2,552 (51.3) | 2,388 (46.5) | |
| Hispanic | 297 (6.0) | 400 (7.8) | |
| Asian/Other/Unknown | 573 (11.5) | 561 (10.9) | |
| Sex (male) | 2,712 (54.5) | 2,840 (55.3) | 0.40 |
| Caesarean delivery | 2,519 (50.6) | 2,340 (45.6) | <0.001 |
| Gestational age, wk | 37 (34, 39) | 37 (34, 39) | 0.06 |
| Birth weight, g | 2820 (2060, 3420) | 2810 (2090, 3400) | 0.99 |
| Management in days 0–3 | |||
| Blood culture obtained | 3,709 (74.5) | 2,592 (50.5) | <0.001 |
| CSF culture obtained | 431 (8.7) | 63 (1.2) | <0.001 |
| CRP obtained | 4,441 (89.2) | 393 (7.7) | <0.001 |
| At least one CRP ≥10 mg/L | 984 (22.2) | 190 (48.4) | <0.001 |
| Infants with >2 CRP obtained | 593 (13.4) | 16 (4.1) | <0.001 |
| Blood culture positive for a pathogen | 23 (0.5) | 15 (0.3) | 0.16 |
| HOL blood culture obtained, h | 1.0 (0.5, 2.3) | 1.2 (1.0, 5.1) | 0.11 |
| HOL antibiotics started, h | 2.5 (1.6, 5.0) | 2.2 (1.4, 4.5) | 0.76 |
| CSF culture positive for a pathogen | 1 (0.0) | 0 | 0.49 |
| Antibiotics initiated in 0–3 days1 | 3,233 (65.0) | 2,607 (50.8) | <0.001 |
| Antibiotic continued for >2 d when blood/CSF cultures did not grow a pathogen2 | 548/3,170 (17.3) | 183/2,532 (7.2) | <0.001 |
| Management in days 4–7 | |||
| Blood culture obtained | 146 (2.9) | 109 (2.1) | 0.009 |
| CSF culture obtained | 77 (1.6) | 17 (0.3) | <0.001 |
| CRP obtained | 389 (7.8) | 123 (2.4) | <0.001 |
| At least one CRP ≥10 mg/L | 79 (20.3) | 46 (37.4) | <0.001 |
| Infants with >2 CRP obtained | 31 (8.0) | 3 (2.4) | 0.04 |
| Blood culture positive for a pathogen | 17 (0.3) | 9 (0.2) | 0.10 |
| HOL blood culture obtained, h | 138.2 (113.8, 155.0) | 117.0 (105.4, 150.4) | 0.40 |
| HOL antibiotics started3, h | 130.0 (114.3, 162.4) | 134.4 (90.5, 158.1) | 0.37 |
| CSF culture positive for a pathogen | 0 | 2 (0.0) | 0.50 |
| New antibiotic course started in 4–7 days4 | 88 (1.8) | 54 (1.1) | 0.002 |
| Antibiotic continued for >2 d when blood/CSF cultures did not grow a pathogen2 | 18/70 (25.7) | 7/46 (15.2) | 0.18 |
| Disposition | |||
| Length of stay by gestational age, d | 4 (3, 15) | 4 (3, 15) | 0.84 |
| <37 wk | 15 (6, 36) | 15 (6, 32) | 0.37 |
| ≥37 wk | 3 (2, 4) | 3 (2, 4) | 0.64 |
| Transferred for higher level of care in ≤7 days after birth | 158 (3.2) | 165 (3.2) | 0.91 |
| Deceased in ≤7 days after birth | 24 (0.5) | 33 (0.6) | 0.28 |
| Deceased before discharge | 38 (0.8) | 44 (0.9) | 0.60 |
Data presented as n (%) or median (Q1, Q3). Missing data – Maternal age (98); Sex (2); Gestational age (2).
More infants may have received antibiotics than infants with blood culture because some infants were born and transferred from outside centers.
The denominator includes all infants with a negative blood/CSF culture who received antibiotics in the respective time frame.
Seven infants (4 in Period 1 and 3 in Period 2) with a positive blood culture in days 4–7 had antibiotics started in days 0–3 after birth; these 7 infants were excluded from comparison of HOL antibiotics started.
New antibiotic course defined as new antibiotics started after a gap of >2 days from the stop date of previous antibiotic course.
Abbreviations – CRP, C-reactive protein; CSF, cerebrospinal fluid; EOS, early-onset sepsis; HOL, hour of life.