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Clinical and economic impacts of a modified-observational screening approach to well-appearing infants born to mothers with chorioamnionitis

Journal of Perinatology (2023)Cite this article

Subjects

Abstract

Objective

Term infants born to mothers with chorioamnionitis are at risk for early-onset sepsis (EOS). We aimed to measure the impact of changing from a categorical to a modified-observational EOS screening approach on NICU admission, antibiotic utilization, and hospitalization costs.

Study design

Single-center retrospective pre-post cohort study of full-term infants born to mothers with chorioamnionitis. Primary outcomes included NICU admission, antibiotic utilization, and hospitalization costs. Outcomes were adjusted for demographic variables. Budget-impact analysis was performed using bootstrapping with replication.

Results

380 term infants were included (197 categorical; 183 modified-observational). There was a significant decrease in NICU admission and antibiotic utilization (p < 0.05) in the modified-observational cohort but no significant difference in per-patient total hospitalization costs. Budget-impact analysis suggested a high probability of cost savings.

Conclusion

A modified-observational approach to evaluating term infants of mothers with chorioamnionitis can reduce NICU admission and unnecessary antibiotic therapy, and may lead to cost-savings.

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Fig. 1: Budget-impact acceptability curve.
Fig. 2: Comparison of screening methods for early-onset sepsis.

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Data availability

Available on request.

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Author information

Authors and Affiliations

  1. University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA

    Cynthia S. Liang, Armand Sebastian, C. Briana Bertoni, Thomas A. Hooven, Mary Kish, Kathleen Schwabenbauer, Toby Yanowitz & Brian C. King

  2. University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA

    Cynthia S. Liang, Armand Sebastian, C. Briana Bertoni, Thomas A. Hooven, Mary Kish, Kathleen Schwabenbauer, Toby Yanowitz & Brian C. King

  3. UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Cynthia S. Liang, Armand Sebastian, C. Briana Bertoni, Thomas A. Hooven, Kathleen Schwabenbauer, Toby Yanowitz & Brian C. King

  4. UPMC Magee-Womens Hospital, Pittsburgh, PA, USA

    Cynthia S. Liang, Armand Sebastian, C. Briana Bertoni, Thomas A. Hooven, Mary Kish, Kathleen Schwabenbauer, Toby Yanowitz & Brian C. King

  5. University of Pittsburgh, School of Arts and Sciences, Department of Statistics, Pittsburgh, PA, USA

    Christopher McKennan

  6. UPMC Children’s Hospital of Pittsburgh Richard King Mellon Institute for Pediatric Research, Pittsburgh, PA, USA

    Thomas A. Hooven

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Contributions

CSL designed the work, acquired, analyzed, and interpreted the data, drafted the manuscript, and substantively revised the manuscript. AS assisted with data acquisition. CM assisted with data analysis. CBB conceptualized and designed the work, and substantively revised the manuscript. TH conceptualized and designed the work, and substantively revised the manuscript. MK conceptualized and designed the work. KS conceptualized and designed the work, and substantively revised the manuscript. TY conceptualized and designed the work, interpreted the data, and substantively revised the manuscript. BCK conceptualized and designed the work, acquired and interpreted the data, and substantively revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Cynthia S. Liang.

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Liang, C.S., Sebastian, A., McKennan, C. et al. Clinical and economic impacts of a modified-observational screening approach to well-appearing infants born to mothers with chorioamnionitis. J Perinatol (2023). https://doi.org/10.1038/s41372-023-01858-3

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