Neonatal Early-Onset Sepsis Risk (Kaiser EOS Framework) — free guideline decision tool

The Kaiser Permanente early-onset sepsis (EOS) framework combines perinatal risk factors with the infant's clinical examination to stratify management in newborns ≥ 34–35 weeks.

Birth risk derives from GA, maximum maternal intrapartum temperature, ROM duration, GBS and intrapartum antibiotics; combined with clinical grade — risk < 1/1000 routine, 1–3 enhanced observation ± culture, > 3 culture + antibiotics; clinical illness → culture + antibiotics regardless of risk.

Use in well-appearing-to-ill newborns ≥ 34–35 weeks to decide between routine care, enhanced observation, and blood culture plus empiric antibiotics.

It replaces a subjective chorioamnionitis diagnosis with objective inputs (maximum maternal temperature, ROM duration), reducing unnecessary antibiotic exposure in well infants. Clinical illness mandates blood culture plus empiric antibiotics regardless of the calculated risk; equivocal exam adds culture plus enhanced observation. The exact quantitative risk per 1000 live births requires the official online calculator; this framework does not substitute a specific risk number.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Gestational age at birth (applies to ≥ 34–35 wk) 38 wk, Maximum maternal intrapartum temperature 38.0 °C, Duration of rupture of membranes 12 h, Maternal GBS status Negative, Intrapartum antibiotics None / ≤ 2 h before delivery, Neonatal clinical grade Well-appearing → Result: Management tier Tier by risk value（Perinatal factors: GA 38 wk, maximum maternal temp 38 °C (maternal fever ≥ 38 °C, increased EOS risk), ROM 12 h, GBS negative, intrapartum antibiotics none/inadequate, Management recommendation: Well-appearing → by risk value: < 1/1000 routine care; 1–3 enhanced observation ± blood culture; > 3 blood culture + empiric antibiotics, Management-tier thresholds: Birth risk < 1/1000 routine care; 1–3/1000 enhanced observation (vital signs q4h × 24 h) ± blood culture; > 3/1000 blood culture + empiric antibiotics. A change in clinical status warrants re-evaluation/recalculation within 24 h） Inputs: Gestational age at birth (applies to ≥ 34–35 wk) 38 wk, Maximum maternal intrapartum temperature 38.0 °C, Duration of rupture of membranes 12 h, Maternal GBS status Unknown, Intrapartum antibiotics Broad-spectrum ≥ 2 h (e.g. cephalosporin/clindamycin), Neonatal clinical grade Clinical illness → Result: Management tier Culture + antibiotics（Perinatal factors: GA 38 wk, maximum maternal temp 38 °C (maternal fever ≥ 38 °C, increased EOS risk), ROM 12 h, GBS unknown, intrapartum antibiotics broad-spectrum ≥ 2 h, Management recommendation: Clinical illness → blood culture + empiric antibiotics (treat as ill regardless of risk value; also investigate and support), Management-tier thresholds: Birth risk < 1/1000 routine care; 1–3/1000 enhanced observation (vital signs q4h × 24 h) ± blood culture; > 3/1000 blood culture + empiric antibiotics. A change in clinical status warrants re-evaluation/recalculation within 24 h）