The Lancet



Papers introducing the calculator prospectively, whole cohort - Kuzniewicz 2017 – Baseline, epoch 1organismClinical condition at birthEOS risk score / 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics?miss/delay(compared to NICE)Streptococcus pneumoniae ill40.363938.9neg15.8None or <2hrsNoEscherichia coliill5.273637.1neg8.6None or <2hrsnoGroup B streptococcusequivocal 1.053637.2neg5.3 none or <2hrsnoStreptococcus ViridansIll6.533937.6neg22.6None or <2hrsnoGroup B streptococcusequivocal0.253836.5neg14.0None or <2hrsnoGroup B streptococcusequivocal0.453736.7neg17.1None or <2hrsnoGroup B streptococcuswell0.353837.9neg14.7None or <2hrsnoEscherichia coliwell0.064036.8neg51.1None or <2hrsnoGroup B streptococcus well0.023736.7pos0None or <2hrsnoStreptococcus Viridans well 0.14 41 37.4 neg 29.1none or <2hrs noGroup B streptococcus well 0.18 39 38.3 pos 0.2None or <2hrsYes – untreated GBS + pyrexia = missGroup B streptococcus well 0.0341 36.7neg 8.3 none or <2hrsNoEnterococcus well 0.01 40 36.2 neg 12.2 none or <2hrsnoStreptococcus Viridans equivocal 0.30 38 36.8 neg 7.1 none or <2hrsnoGroup B streptococcus equivocal 0.40 38 37.1 neg 3.1 None or <2hrsNoEnterococcus equivocal 0.35 37 36.6 neg 8.1 None or <2hrsNo Escherichia coli 0.7 1.2 ill 3.80 41 37.2 neg 13.1 none or <2hrsNoGroup B streptococcus equivocal 1.95 36 37.2 neg 24.2 None or <2hrsYes – PROM + prem = delayEscherichia coli well0.49 38 38.6 neg 11.7None or <2hrsyes - ? maternal sepsis – as per Dr Kuzniewicz = missGroup B streptococcus well 0.07 40 37.4 neg 8.8 none or <2hrsnoListeria monocytogeneswell 0.81 35 39.2 unknown 1.7 GBS abx >2hrsYes – pyrexia + prematurity = missEscherichia coli well 3.15 41 39.7 neg 10.5 none or <2hrsNoListeria monocytogenes well 0.01 39 37 unknown 0.0 none or <2hrsnoGroup B streptococcus ill 26.25 39 39.3 neg 16.0 GBS abx >2hrsNoPapers introducing the calculator prospectively, whole cohort - Kuzniewicz 2017 – Learning, epoch 2OrganismClinical Classification at BirthEOS risk score / 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal AntibioticsClinical Symptomsmiss compared to NICE1Group B streptococcus well0.023937pos0.0none or <2hrs14.5 hrsno2Escherichiacoliequivocal10.464139.1pos17.1GBS abx >2hrsAt birthno3Group B streptococcuswell0.183737.2pos22.8none or <2hrsnilno4Group B streptococcuswell0.104137.3neg27.6none or <2hrs3 hrsno5Escherichiacoliill6.743937.6neg25.0none or <2hrsAt birthno6Streptococcus Viridanswell2.133939.5neg16.6none or <2hrs12 hrsyes - ? maternal sepsis – as per Dr Kuzniewicz = miss7Group B streptococcusill1.274036.9neg4.4none or <2hrsAt birthmaybe - ill at birth – may have had NICE clinical indicators8Escherichia coliill0.214036.3unk0.0none or <2hrsAt birthmaybe - ill at birth– may have had NICE clinical indicators9Stretreptococcus Viridanswell0.084137.7neg2.4none or <2hrs40 hrsno10Escherichiacoliill76.644039.3neg16.6none or <2hrsAt birthno11Escherichiacoliwell0.164138.2neg1.4none or <2hrsNo symptomsyes - ? maternal sepsis – as per Dr Kuzniewicz = miss12Streptococcus Viridansill0.643736.8neg0.0none or <2hrsAt birthmaybe – ill at birth– may have had NICE clinical indicators13Group B streptococcusequivocal0.303836.8neg8.9none or <2hrsAt birthmaybe - equivocal14Escherichiacoliill95.754039.3neg162.7Broad abx 2-4 hrsAt birthno15Group B streptococcuswell0.023736.3neg9.7none or <2hrsNo symptomsnoPapers introducing the calculator prospectively, whole cohort - Kuzniewicz 2017 – calculator period, epoch 3organismClinical condition at birthEOS risk/ 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics?miss (compared to NICE)Klebsiella pneumoniae well 0.04 40 36.8 neg 17.9 None or <2hrsNoStreptococcus Viridans ill 4.22 36 37.2 neg 6.8 None or <2hrsnoEscherichia coli ill 7.58 41 37.5 neg 18.2 None or <2hrsnoGroup B streptococcus ill 1.90 41 36.7 neg 15.2 None or <2hrsnoEscherichia coli equivocal 0.65 39 37.2 neg13.2None or <2hrsnoGroup B streptococcus well 2.29 41 39.1 pos 12.9 None or <2hrs Yes – untreated GBS, mat pyrexia = delayEscherichia coli ill 6.74 38 38.1 neg 2.5 none or <2hrsNo Group B streptococcuswell 0.03 39 37.2 neg 3.0 none or <2hrsNoEscherichia coliwell 0.07 39 37.8 pos 9.5 GBS abx > 2hrsNoListeria monocytogenes well 0.02 36 36.6 unknown 0.0 None or <2hrsNoEscherichia coli well 0.15 40 38 neg 7.1 none or <2hrs Yes -? chorioamnionitisStreptococcus Viridans ill 4.85 35 37.5 unknown 0.0 none or <2hrsNoPapers introducing the calculator prospectively, whole cohort – Dhudasia 2018organismClinical condition EOS riskAt birth/ 1000EOS risk after examination/ 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics?miss (compared to NICE)1Escherichia coli Respiratory distress treated with CPAP1.547.6640+4 101.8°F =38.8Cneg39.1broad-spectrum 2.5 hrs before deliverypossible delay. Using NICE guidelines, would have been commenced on abx at birth but may have taken some time to develop resp. distress2Group B streptococcusLethargy & tachypnoea at 36hrs0.3N/A >24hrs old when symptomatic37+398.9°F =37.2Cneg 14.8noneyes – tachypnoea > 4 hours of age is a NICE red flag3Escherichia coli well11.454.7240+1 102.8°F =39.3Cneg53.0noneno4Escherichia coli well3.411.4040 102.2°F =39Cneg12.3nonepossible delay – mother likely to have been commenced on abx. Depends which score was used.Papers introducing the calculator prospectively, whole cohort – Strunk 2018organismClinical condition at birthEOS riskAt birth/ 1000EOS riskafter examination/ 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics? miss (compared to NICE)1unknownunknownunknownempirical treatment unknownunknownunknownunknownunknownNo2unknownunknownunknownempirical treatmentunknownunknownunknownunknownunknownnoPapers prospectively (theoretically) testing the Calculator, whole cohort - Goel 2019organismClinical condition EOS risk after examination / 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics?miss (compared to NICE)1Not statedNot statedNot statedNot statedNot statedNot statedNot statedNot statedPicked up (by both methods)2Not statedNot statedNot statedNot statedNot statedNot statedNot statedNot statedPicked up (by both methods)3Not statedNot statedNot statedNot statedNot statedNot statedNot statedNot statedPicked up (by both methods)4Not statedNot statedNot statedNot statedNot statedNot statedNot statedNot statedMissed, but also missed by NICE5Not statedNot statedNot statedNot statedNot statedNot statedNot statedNot statedMissed, but also missed by NICEProspective, single-centre cohort, whole cohort - Arora 2019organismClinical condition EOS risk after examination / 1000Gestational ageHighest maternal temp(°C)GBS statusROM (hrs)Maternal antibiotics? miss (compared to NICE)1Not statedNot statedNot statedNot statedNot statedNot statedNot statedNot statedno Single centre, prospective quality improvement project, whole cohort – Stipelman 2019organismClinical condition EOS risk at birth / 1000EOS risk after examination/ 1000Gestational ageHighest maternal tempGBS statusROM (hrs)Maternal antibiotics?miss (compared to NICE)1Group B Streptococcus‘clinically ill at 6 hrs’ (temperature instability + oxygen requirement)0.090.04, 0.43, 1.83Not statedNot statedNot statedNot statedNot statedyes = would have fitted NICE clinical indicators and been commenced on abx 2Enterococcus faecalisunknown0.250.10, 1.27, 5.37Not statedNot statedNot stated‘prolonged’not stated, but ‘maternal chorioamnionitis’yes – would have started antibiotics at birth3Escherichia coliunknown0.070.03, 0.34, 1.43Not statedNot statedNot statedNot statedNot statedno, only one (non-red flag) clinical indicator (fever at 45 min of life)Theoretically/retrospectively testing the calculator – mothers with chorioamnionitis – Shakib 2015organismClinical condition at birthEOS riskafter examination/ 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics? miss (compared to NICE)1Group B StreptococcusIll 7.85unknownunknownpositiveunknownGBS specific abxnoTheoretically/retrospectively testing the calculator – mothers with chorioamnionitis – Money 2017organismClinical condition at birthEOS riskafter examination/ 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics? miss (compared to NICE)1Enterococcuswell0.7742+1100.6 F=38.1CNot stated20Not statedYes – because these babies were chorioamnionitis-exposedPapers Retrospectively (theoretically) testing the Calculator – mothers with chorioamnionitis – Carola 2018organismClinical condition EOS risk at birth/ 1000EOS risk after examination/ 1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics?miss (compared to NICE)1Group B Streptococcuswell4.021.65Not statedNot statedNot statedNot statedNot statedpossible delay – depending which score was used.2Escherichia coliwell2.390.98Not statedNot statedNot statedNot statedNot statedyes3Alpha haemolytic streptococciequivocal5.1525.25Not statedNot statedNot statedNot statedNot statedno4Strep intermediusill3.4468.19Not statedNot statedNot statedNot statedNot statedno5Strep sanguinisill2.0341.34Not statedNot statedNot statedNot statedNot statedpossible delay – until the baby became unwell – whereas would have been started at birth using guidelinesProspective, single-centre prospective cohort – mothers with chorioamnionitis Sharma 2019organismClinical condition EOS score at birth / 1000EOS risk after examination/1000Gestational ageHighest maternal temp (°C)GBS statusROM (hrs)Maternal antibiotics? miss (compared to NICE)1Not statedclinical illness- required CPAP36 Not statedNot statedNot statedNot statedNot statedNot statedno Single centre, retrospective record/chart review, as part of a separate quality improvement project – mothers with chorioamnionitis Joshi 2019organismClinical condition EOS score at birth / 1000Gestational ageHighest maternal tempGBS statusROM (hrs)Maternal antibiotics? miss (compared to NICE)1GBSTachypnoea at 24 hours of age0.93 4038.3°Cpositive1nilyes Table S1 – details of EOS cases across the included studies ................
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