Pediatric Hospital Medicine – SHM, AAP, APA

View all recommendations from this society

January 11, 2021

Do not start IV antibiotic therapy on well-appearing newborn infants with isolated risk factors for sepsis such as maternal chorioamnionitis, prolonged rupture of membranes, or untreated group-B streptococcal colonization. Use clinical tools such as an evidence-based sepsis risk calculator to guide management.

Unnecessary exposure of infants to antibiotics is associated with increased parental anxiety, length of stay, increased cost, gut microbiome dysbiosis, necrotizing enterocolitis and possibly allergic and autoimmune diseases. Antibiotic therapy often leads to transfers to higher levels of care and thus decreased maternal-infant bonding. The use of evidence-based sepsis calculators has demonstrated reductions in antibiotic use of 50% or more without a concomitant increase in the incidence of early onset sepsis.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

A diverse committee with representatives from the Society of Hospital Medicine’s Pediatrics Special Interest Group, the American Academy of Pediatrics’ Section on Hospital Medicine and the Academic Pediatric Association’s Hospital Medicine Special Interest Group solicited a list of recommendations with specified criteria from colleagues and the various society listservs. Through an iterative process, recommendations were formatted, merged, and presented with an evidence review of publications from the past 10 years supporting each recommendation. From over 100 initial recommendations and through 2 rounds of a modified Delphi process, the highest scoring recommendations were chosen to represent the Pediatric Hospital Medicine Choosing Wisely list. The list was endorsed by the Boards of the Society of Hospital Medicine and the Academic Pediatric Association and peer reviewed by various AAP specialty groups and endorsed by the American Academy of Pediatrics’ Executive Committee.


K.M. Puopolo, W.E. Benitz, T.E. Zaoutis, Committee on Fetus and Newborn, Committee on Infectious Diseases, Management of neonates born at ≥35 0/7 weeks’ gestation with suspected or proven early-onset bacterial sepsis. Pediatrics, 142 (2018)
Leonardi BM, Binder M, Griswold KJ, Yalcinkaya GF, et al; Utilization of a Neonatal Early-Onset Sepsis Calculator to Guide Initial Newborn Management. Pediatr Qual Saf. 2019 Sep 23;4(5):e214.
Goel N, Shrestha S, Smith R, Mehta A, et al; Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population. Arch Dis Child Fetal Neonatal Ed. 2019.