Analyzing Septic Workups Performed on Neonates at the Coombe Hospital: An Audit Study

Background: Sepsis remains a significant cause of morbidity and mortality among neonates. Owing to its non-specific clinical presentation, clinicians often have a low threshold for performing septic work-ups and initiating empirical antibiotics. On the contrary, positive sepsis rates remain low. While a cautious approach reduces the risk of missed cases, it leads to over-investigation, unnecessary antibiotic exposure, and prolonged hospital admissions. Balancing early detection with antibiotic stewardship in modern neonatal care is vital 1. This audit evaluated current practices for septic work-ups in neonates with a gestation of ≥35 weeks, born at The Coombe Hospital, Dublin, Ireland. Methodology: A retrospective audit was conducted over a six-month period (January 2023 to July 2023). Data were analyzed from 284 charts; 155 were neonates with a gestation of ≥35 weeks. Parameters comprised of gestational age, presenting presentation, maternal septic risk factors, intrapartum antibiotic prophylaxis (IAP), blood culture results, and antibiotic duration. Findings were compared with the Coombe Hospital guidelines. Results: Respiratory distress (43%) was the most frequent indication for work-up. Forty-two percent of cases had no maternal risk factors. Only three percent of blood cultures were positive, 2 Coagulase-negative staphylococci and one Escherichia coli isolate. Seventy-six percent of neonates had antibiotics discontinued at 36 hours, indicating good stewardship. Nonetheless, some culture-negative cases had continuation of treatment. Twenty-eight percent of mothers with risk factors received no IAP, suggesting missed prophylactic opportunities. Conclusion: Despite widespread antibiotic use, most blood cultures were negative, reflecting a cautious approach. While respiratory distress is a common trigger for investigation, it is a non-specific symptom that may lead to over-investigation. Incomplete IAP and variable antibiotic durations highlight areas for improvement in clinical practice. Enhancement in documentation and standardization of protocols is essential for result accuracy and refining of sepsis management. A repeat audit post-intervention is recommended to assess the impact of these quality improvements. (image)