G225(P) Meows (modified early obstetric warning scores) can reduce the number of asymptomatic babies treated with intravenous (IV) antibiotics at birth

Introduction The ‘Neonatal infection (early onset): antibiotics for prevention and treatment’ NICE Clinical guideline recommends antibiotics are started where parenteral antibiotic treatment is given to mothers for confirmed or suspected invasive bacterial infection. Recent changes in the Obstetric ‘Green Guide’ means there is now a lower threshold (temperature ≥37.5° x2 or ≥38° x1) for starting IV antibiotics in labouring and postpartum women. These cases are labelled as ‘maternal sepsis’. Our clinical observation suggested that many newborn babies are being treated with antibiotics where there is minimal evidence of invasive bacterial infection or sepsis in their mothers. Methods A retrospective cohort pilot study was undertaken, examining the notes of babies treated with IV antibiotics on the postnatal wards of a district general hospital during May 2018 to determine the reason for starting antibiotics along with their C-reactive protein (CRP). The notes for mothers of babies treated for maternal sepsis were examined to determine MEOWS during and after labour. Results In the pilot, 44 asymptomatic babies were treated at birth. 68% (n=30) were for maternal sepsis. We defined ‘MEOWS Positive’ as MEOWS of 5 across all parameters, or 3 in one parameter. 63% of babies treated for maternal sepsis (n=19)(43% of all babies treated from birth) would not have met a MEOWS Positive threshold for treatment. 64% (n=7) of babies in the MEOWS positive group, but only 16% (n=3) in the MEOWS negative group had a significant CRP rise. There were no significant microbiological results In either group. A full study examining 6 months of data across the local neonatal network is underway and will be presented. Conclusions Many babies are treated at birth simply because of maternal IV antibiotic use but where MEOWS is negative. There is a strong correlation between high MEOWS and CRP rise in babies. If these results are reproduced in our full study, MEOWS could be used as a tool to decide whether to treat, or merely observe from birth. This would significantly reduce the number starting IV antibiotics, reducing the associated risks, costs, and length of hospital stay.