# Optimizing neonatal management in the prescence of intrapartum maternal fever via the integration of an early-onset sepsis risk calculator and dynamic inflammatory markers

## TL;DR

This study evaluates how combining a sepsis risk calculator with inflammatory markers improves early detection and management of neonatal sepsis in infants born to mothers with intrapartum fever.

## Contribution

The study introduces a novel approach integrating an EOS risk calculator with dynamic inflammatory markers to enhance sepsis prediction in neonates.

## Key findings

- 61 out of 265 neonates born to mothers with intrapartum fever were diagnosed with early-onset sepsis.
- CRP and IL-6 levels were significantly higher in infected neonates, with CRP showing the highest diagnostic accuracy (AUC: 0.84).
- Combining the EOS risk calculator with CRP and IL-6 improved diagnostic performance (AUC: 0.85).

## Abstract

Intrapartum maternal fever is associated with an increased risk of early-onset sepsis (EOS) in infants. However, EOS has a high mortality rate, and its clinical symptoms are variable and often atypical, posing significant challenges for early identification and treatment. This study aims to evaluate the performance of an EOS risk calculator in combination with inflammatory markers for predicting EOS in infants born to mothers with intrapartum fever while maintaining neonatal safety in China.

This was a retrospective cohort study involving 265 term neonates (gestational age: 37–41⁶/₇ weeks) born between the 1st of January 2024 and the 30th of June at the International Peace Maternity and Child Health Hospital. Eligible neonates were admitted to the neonatal intensive care unit (NICU) due to a intrapartum maternal fever (temperature >37.5 °C). We collared and reviewed laboratory data and medical charts of all included neonates. EOS risk scores for all neonates were calculated using the EOS risk calculator, and the results were analyzed and compared with blood biomarkers.

Of the 265 neonates, 61 (23.0%) were diagnosed with EOS. Among the 204 (77.0%) low-risk newborns predicted by the EOS risk calculator, none developed culture-confirmed sepsis. Infected neonates exhibited significantly higher levels (P < 0.01) of inflammatory markers, including C-reactive protein (CRP) and Interleukin 6 (IL-6), compared to uninfected counterparts. Receiver Operating Characteristic (ROC) Curve analysis revealed that when the EOS risk calculator was combined with inflammatory markers, CRP had the highest discriminative capacity [Area Under Curve (AUC): 0.84], while IL-6 exhibited moderate accuracy (AUC: 0.72). The combination of CRP and IL-6 further improved diagnostic performance (AUC: 0.85).

Combined with inflammatory markers, the EOS risk calculator demonstrated good predictive accuracy and a high safety profile for the clinical management of neonates with presumed sepsis, which helps reduce antibiotic use and promotes rational use of medical resources.