Fellow Physician Loma Linda University Children's Hospital Loma Linda, California, United States
Background: NICU patients with hypoxic-ischemic encephalopathy (HIE) present with clinical signs and symptoms that are difficult to distinguish from hypothermia-induced hemodynamic instability and severe sepsis. Even with the history of hypoxia and known mechanism of neuronal injury that leads to the clinical presentation, clinicians are challenged with the need to rule out acute infection as the presenting etiology. As a result, infants receive empiric antibiotics and undergo an infectious evaluation for an extended period of time. Objective: This quality improvement project aims to reduce antibiotic duration among infants with HIE by 20% within 12 months. Balancing measures will consist of evaluating patients with antibiotic treatment failure with the need to resume antibiotics within 7 days of treatment completion and evaluating rates of infant death. Design/Methods: Baseline retrospective data has been collected between January 2021 and December 2022 to evaluate antibiotic use patterns, delivery room information, and associated morbidities. A total of 98 patients (31 inborn and 67 outborn) were identified during this period. One patient was treated for culture-positive sepsis, 59 patients were treated for culture-negative sepsis, and 38 patients had sepsis ruled out. The overall usage of antibiotics was 5.6 days per patient. The QI project aims to identify infectious risk factors, create infectious evaluation guidelines to reduce antibiotic duration, and provide education for providers. The anticipated guidelines will contain recommendations for early, safe discontinuation of antibiotics by trending inflammatory markers, assessing clinical stability, and evaluating infectious risk factors. We hope to finish our first PDSA cycle by February 2024 and have preliminary data by March 2024.
.jpg "Chaitra Manjunath, MBBS, MD (she/her/hers) photo")