Supplementary Material for: Enhanced category-based risk assessment for neonatal early-onset sepsis: a prospective observational study

Introduction Compared with multivariate risk assessment, traditional category-based risk assessment (CRA) approaches for neonatal early-onset sepsis (EOS) screening are straightforward to use and do not require electronic devices. However, they are associated with higher rates of antibiotics use. This study aims to evaluate the performance of a novel enhanced CRA (eCRA) framework on EOS admissions and antibiotics use and to investigate whether a modified version with adjustments in risk factors weighting can allow its performance to match the EOS calculator, while remaining easy to implement. Method This is a prospective, single-center, two-phase observational study. Infants of all gestations delivered in a tertiary hospital in Hong Kong, with risk factors or clinical features of EOS were recruited. Phase I: A novel eCRA framework (period 2) was compared with the CDC 2010-based protocol (period 1). Phase II: A modified eCRA framework was compared theoretically with the EOS calculator. EOS-specific admissions and antibiotics use were measured. Results Phase I: 1,025 at-risk infants were recruited during period 2 and compared with 757 infants of period 1. Admissions and antibiotics use decreased from 45.8% to 29.4% and 41.1% to 28.2% respectively. Antibiotics among those at-risk but well-appearing infants decreased from 25.3% to 16.3% (p<0.001 for all). Phase II: antibiotics use was similar (7.3% vs 6.4%, p=0.42) between the modified eCRA framework and the EOS calculator. Conclusions An eCRA framework can effectively and safely provide individualized guidance for EOS screening without need for tools such as the EOS calculator.