# Clinical Outcomes of the Adapted AAP 2019 Guidelines on Early Onset Sepsis in Thailand

## TL;DR

This study shows that adapting the AAP 2019 guidelines in Thailand reduced unnecessary antibiotic use in neonates with early-onset sepsis while ensuring timely treatment.

## Contribution

The study evaluates the clinical outcomes of adapting the AAP 2019 guidelines in a Thai hospital setting.

## Key findings

- Antibiotic use in neonates decreased from 11% to 7.9% after guideline implementation.
- A case of GBS septicemia was promptly managed using the adapted guidelines.
- Unnecessary investigations were reduced without compromising timely antibiotic administration.

## Abstract

Background: Antibiotic overuse in early-onset sepsis (EOS) remains a significant clinical challenge. Panyananthaphikkhu Chonprathan Medical Center adapted the 2019 American Academy of Pediatrics (AAP) guidelines by integrating the EOS calculator with enhanced observation. This study aimed to evaluate clinical outcomes before and after implementation in Thailand, focusing on timely initiation of empirical antibiotics in neonates with EOS and the reduction in unnecessary investigations and antibiotic exposure. Methods: This retrospective cohort observational study included neonates ≥ 35 weeks’ gestation. Participants were divided into two groups: “before” (1 February 2017–31 January 2018) and “after” (1 February 2023–31 January 2024) guideline implementation. Data were analyzed using Pearson chi-square, Mann–Whitney U-test, and binary logistic regression, with statistical significance defined as p < 0.05. Results: Among 3040 neonates (1639 before and 1401 after guideline implementation), antibiotic use declined from 11% to 7.9% (p < 0.001), with an Odds Ratio of 1.46 (95% Confidence Interval 1.14–1.87). Following the implementation of the Adapted AAP 2019 guidelines, a neonate with GBS septicemia was identified at birth with respiratory distress and was promptly started on antibiotics per the guideline. Conclusions: The Adapted AAP 2019 guidelines improved EOS management by reducing unnecessary investigations and antibiotic use while ensuring timely empirical antibiotic administration, as shown by the prompt management of a GBS septicemia case. Key to this reduction lies in the Adapted AAP 2019 guidelines, which provide clear definitions of EOS and recommend serial clinical observation for asymptomatic neonates born to mothers with risk factors for EOS.