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Background The 2012 Neonatal Early Onset Infection Guideline by National Institute for Clinical Excellent (NICE) [CG149], led to an increase in antibiotic use in well newborns. The Kaiser Permanente Sepsis Risk Calculator (KP-SRC) uses the population's background incidence of EOS, objective information at birth and the infant's clinical presentation to evaluate risk of neonatal EOS in infants >34 weeks gestation. This has safely shown to reduce the use of antibiotics. During the COVID-19 pandemic, the local Operational Delivery Network endorsed the use of the KP-SRC. Objectives To show implementation of KP-SRC can safely and effectively reduce the incidence of antibiotic use in well babies over 34 weeks gestation without an increase in missed cases of sepsis. Methods KP-SRC was implemented in 4 neonatal units. KPSRC is used on all babies with risk factors for infection in accordance with the NICE EOS guideline [CG149] and antibiotics are started according to the recommended outcome. There was slight variation in the parameters used by the units in the calculation of KP-SRC (i.e. Infection incidence rate of 0.8/1000 in 2 units and 0.6/1000 in the other 2 units). Blood culture data during the first seven days of life was provided on a monthly basis by the laboratories. Babies < 34 weeks gestation were excluded and clinical details of the remaining babies were reviewed, particularly with respect to positive blood cultures and readmissions following discharge home. Data was reviewed over a consecutive 5 month period prior to implementation of the KP-SRC (1 Sept 2019 - 31 Jan 2020), and post implementation (1 Sept 2020 - 31 Jan 2021). Results There was a percentage reduction in blood cultures taken in the post KP-SRC implementation period between the 4 units of 52 to 85% (mean 60%). There were 5 positive blood cultures, all babies were commenced on antibiotics at birth in accordance with the KP-SRC recommendation. Twenty babies were started on antibiotics after 24 hours of age and received 5 days of antibiotics. Twelve had no risk factors for infection and would not have been picked up by NICE. Of the eight assessed by KP-SRC, two were admitted to the neonatal unit on day 2 with tachypnea but did not require respiratory support. Only one baby was readmitted following discharge and received 5 days of antibiotics. This baby was readmitted on day 7 with apnoea requiring ventilation. There was a history of maternal prolonged rupture of membranes and mild maternal pyrexia but the baby was well in the immediate postnatal period. Blood cultures were negative with normal CRP's. Conclusions The KP-SRC can lead to a safe and consistent reduction in the number of well babies receiving antibiotics post-delivery. All babies with positive blood cultures were on antibiotics as guided by the KP-SRC and there were no missed cases of sepsis.

Data on new-onset type 1 diabetes during the coronavirus disease 2019 (COVID-19) pandemic, particularly in children, are limited. A recent U.S. multicenter study reported outcomes in 64 adults and children with type 1 diabetes, and confirmed or suspected COVID-19. However, only six patients presented with new-onset type 1 diabetes (1). We report multicenter regional data from North West London (NWL) of new-onset type 1 diabetes and diabetic ketoacidosis (DKA) in children up to the age of 16 years during the peak of the COVID-19 pandemic. We collected data from five inpatient units (four National Health Service [NHS] Trusts) comprising the NWL Pediatric Diabetes Network between 23 March (coinciding with the commencement of the U.K. Government lockdown) and 4 June 2020. Thirty children aged 23 months to 16.8 years presented with new-onset type 1 diabetes (Table 1). We observed an apparent increase in two units, with 10 cases each (versus typically 2 and 4 cases, respectively, for April/May combined in the previous 5 years). Rates in the other three units were similar to previous years. A high proportion of children (21/30, 70%) presented with DKA, …