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In Brief | Division News
Building on earlier work that was featured last year in Pediatrics, Phase II of a quality improvement initiative at Lucile Packard Children’s Hospital (LPCH) Stanford shows that managing well-appearing chorioamnionitis-exposed late preterm and term infants with a clinical exam-based approach can also be successfully implemented in the newborn nursery. The approach is the first in the United States to describe relying on clinical examination alone to determine the need for antibiotics in this specific subgroup of infants. The impact of the initiative has been remarkable. Antibiotic use has declined by >92 percent in chorioamnionitis-exposed infants born at LPCH, representing hundreds of infants saved from unnecessary antibiotic exposure. It addition, these infants now remain with their mother in couplet care during the birth hospitalization, which helps to foster bonding and breastfeeding. On a national level, the project’s leadership has helped move the needle on the management of late preterm and term infants at risk for suspected early-onset bacterial sepsis. The updated 2018 American Academy of Pediatrics (AAP) Guidelines now list serial clinical examination as one of the approaches that can be used to risk stratify infants for early-onset sepsis. Co-authors of a Hospital Pediatrics paper on the project findings include lead author Neha Joshi, MD, Arun Gupta, MD, Ronald Cohen, MD, William Benitz, MD, and senior author Adam Frymoyer, MD.