Guideline Adaptation for Treatment of Neonatal Sepsis and Evaluation of its Effectiveness in NICU of Alzahra Teaching Hospital

Abstract

The purpose of this study was to localize the antibiotic treatment of evidence-based neonatal sepsis based on the frequency of neonatal sepsis bacteria in the NICU section of Alzahra hospital in Tabriz and to evaluate the implementation of this clinical guide.Given the importance of the third goal, the methodology and the results of the clinical guidelines assessment were presented in this abstract. Method and materials: This study included two parts. In the primary part, sepsis treatment protocols were extracted and then localized, and in the second part of the study, the protocol was evaluated.The type of study was a before and after which performed on infants admitted to NICU section of Al-Zahra Hospital in Tabriz.Using the GPower software, the required sample size was calculated to be 300 subjects per group (95% confidence and 80% power). These infants were studied in both groups (before and after). Exclusion criteria were: infants with congenital anomalies incompatible with life and chromosomal disorders, major heart disease, bleeding disorders, immune deficiency diseases, undetected congenital diseases, and babies transferred to another center. In case of sepsis, antibiotic therapy was performed on the basis of guideline during the hospitalization. A checklist including short-term complications including death, discharge and transmission, grade 2 necrotizing enterocolitis, sepsis, and the total days of antibiotic treatment, hospital stay and bacteriological information were completed and recorded by the assistants. The data obtained from the study were analyzed by statistical methods such as the mean comparison test for independent groups and chi-square test or Fischer's exact test and calculation of odds ratios with 95% confidence intervals by SPSS 16 software. Results: This study showed a higher prevalence of coagulase-negative staphylococci in neonates with sepsis in both groups before and after the intervention. In the pre-intervention group, positive blood cultures were 22 cases (1.4% early-sepsis and 6.6% late-sepsis) and in the post-intervention group, were 20 cases (1% early-sepsis and 5.8% late-sepsis). The number of neonatal death was 40 before the implementation of the guideline, and dropped to 17 after the implementation of the guideline. This difference was statistically significant (p = 0.001). The number of newborns with NEC in the first group was 11, which was reduced to 4 in the second group, but this difference was not significant (p = 0.663).The number of infants with late sepsis in the first group was 18 and in the second group was 17, and this difference was not significant (p = 0.763).The duration of hospitalization in the first group was 16.38 days and in the second group was 17.75 days, and this difference was not statistically significant.