ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
This article is part of the Research TopicAdvancing pediatric critical care: Sepsis, immune dysregulation, and precision therapiesView all 13 articles
Optimizing Neonatal Management in the Prescence of Intrapartum Maternal Fever via the Integration of an Early-Onset Sepsis Risk Calculator and Dynamic Inflammatory Markers
Provisionally accepted
- International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Background: Intrapartum maternal fever is associated with an increased risk of early-onset sepsis (EOS) in infants. However, EOS has a high mortality rate, and its clinical symptoms are variable and often atypical, posing significant challenges for early identification and treatment. This study aims to evaluate the performance of an EOS risk calculator in combination with inflammatory markers for predicting EOS in infants born to mothers with intrapartum fever while maintaining neonatal safety in China. Methods: This was a retrospective cohort study involving 265 term neonates (gestational age: 37-41⁶/₇ weeks) born between the 1st of January 2024 and the 30th of June at the International Peace Maternity and Child Health Hospital. Eligible neonates were admitted to the neonatal intensive care unit (NICU) due to a intrapartum maternal fever (temperature > 37.5 °C). We collared and reviewed laboratory data and medical charts of all included neonates. EOS risk scores for all neonates were calculated using the EOS risk calculator, and the results were analyzed and compared with blood biomarkers. Results: Of the 265 neonates, 61 (23.0%) were diagnosed with EOS. Among the 204 (77.0%) low-risk newborns predicted by the EOS risk calculator, none developed culture-confirmed sepsis. Infected neonates exhibited significantly higher levels (P < 0.01) of inflammatory markers, including C-reactive protein (CRP) and Interleukin 6 (IL-6), compared to uninfected counterparts. Receiver Operating Characteristic (ROC) Curve analysis revealed that when the EOS risk calculator was combined with inflammatory markers, CRP had the highest discriminative capacity (Area Under Curve (AUC): 0.84), while IL-6 exhibited moderate accuracy (AUC: 0.72). The combination of CRP and IL-6 further improved diagnostic performance (AUC: 0.85). Conclusions: Combined with inflammatory markers, the EOS risk calculator demonstrated good predictive accuracy and a high safety profile for the clinical management of neonates with presumed sepsis, which helps reduce antibiotic use and promotes rational use of medical resources.
Keywords: biomarker, Early-onset sepsis, early-onset sepsis calculator, Maternal intrapartum fever, neonate
Received: 22 Jul 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Wu, Liu and Fu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xuemei Fu
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