To assess the real-world performance of the Serial Clinical Observation (SCO) strategy in identifying and treating Early- Onset Sepsis (EOS) cases, and to compare it with the recommendations the Neonatal Sepsis Calculator (NSC) would have provided. This multicentre study analyzed prospectively culture-confirmed EOS cases caused by Group B Streptococcus (GBS) or Escherichia coli (2016–2022) in term and late-preterm infants managed with the SCO approach in Italy. We evaluated the proportion of infants assigned to routine care at birth and the time to antibiotics. NSC scores at 4, 12, and 24 h after birth were retrospectively calculated. Of 57 EOS cases, 23 (40.4%) had no maternal risk factors. Fifty infants developed clinical signs of illness either at birth (n = 24) or postnatally (n = 26). Among those symptomatic at birth, the median time to antibiotic initiation was 2.0 h (IQR 1.0–5.75). “Major” clinical signs according to the SCO protocol were present in 79.2%, prompting immediate antibiotics. Retrospective NSC application at 4 h would have recommended antibiotics in 87.5%. Of the 26 who became symptomatic after birth, 16 (61.5%) were assigned to routine care. The median time from disease onset to treatment was 6.0 h (IQR 2.0–14.0). At 4 h, NSC would have assigned 19 (73.1%) of these infants to routine care. Subtle neurological signs (i.e. hypotonia, irritability, altered consciousness) were frequently observed at onset in infants who developed severe disease. Conclusion: Most EOS cases were appropriately identified among infants with clinical signs at birth, but not among those initially well-appearing. Close clinical observation throughout the first 48 h of life, along with careful attention to “major” signs—including subtle neurological signs—may improve EOS management.
Erratum: Correction to: Real-world use of Serial Clinical Observation in culture-proven early-onset sepsis: timing of recognition, treatment and retrospective comparison with the Neonatal Sepsis Calculator (European journal of pediatrics (2026) 185 5 PII: 368 DOI: 10.1007/s00431-026-06905-7.) / Miselli, F., Lugli, L., Dragone, G., Bedetti, L., Spinedi, S., Capretti, M., Marrozzini, L., Di Luca, L., Fanaro, S., Gambini, L., Biasucci, G., Piccinini, G., Scarponi, D., Papa, I., Nanni, F., Baroni, L., Pagano, R., Capone, V., Berardi, A.. - In: EUROPEAN JOURNAL OF PEDIATRICS. - ISSN 1432-1076. - 185:6(2026). [10.1007/s00431-026-07005-2]
Erratum: Correction to: Real-world use of Serial Clinical Observation in culture-proven early-onset sepsis: timing of recognition, treatment and retrospective comparison with the Neonatal Sepsis Calculator (European journal of pediatrics (2026) 185 5 PII: 368 DOI: 10.1007/s00431-026-06905-7.)
Miselli F.;Lugli L.;Fanaro S.;Biasucci G.;Papa I.;Baroni L.;
2026-01-01
Abstract
To assess the real-world performance of the Serial Clinical Observation (SCO) strategy in identifying and treating Early- Onset Sepsis (EOS) cases, and to compare it with the recommendations the Neonatal Sepsis Calculator (NSC) would have provided. This multicentre study analyzed prospectively culture-confirmed EOS cases caused by Group B Streptococcus (GBS) or Escherichia coli (2016–2022) in term and late-preterm infants managed with the SCO approach in Italy. We evaluated the proportion of infants assigned to routine care at birth and the time to antibiotics. NSC scores at 4, 12, and 24 h after birth were retrospectively calculated. Of 57 EOS cases, 23 (40.4%) had no maternal risk factors. Fifty infants developed clinical signs of illness either at birth (n = 24) or postnatally (n = 26). Among those symptomatic at birth, the median time to antibiotic initiation was 2.0 h (IQR 1.0–5.75). “Major” clinical signs according to the SCO protocol were present in 79.2%, prompting immediate antibiotics. Retrospective NSC application at 4 h would have recommended antibiotics in 87.5%. Of the 26 who became symptomatic after birth, 16 (61.5%) were assigned to routine care. The median time from disease onset to treatment was 6.0 h (IQR 2.0–14.0). At 4 h, NSC would have assigned 19 (73.1%) of these infants to routine care. Subtle neurological signs (i.e. hypotonia, irritability, altered consciousness) were frequently observed at onset in infants who developed severe disease. Conclusion: Most EOS cases were appropriately identified among infants with clinical signs at birth, but not among those initially well-appearing. Close clinical observation throughout the first 48 h of life, along with careful attention to “major” signs—including subtle neurological signs—may improve EOS management.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
