1) Our institutional practice (High volume, high acuity delivery service, 12k births/year) is to have a 'Chorio' nursery monitored and staffed by NICU RN and, covered by a pediatric hospitalist. Babies are admitted there for culture, antibiotics and screening CBC and CRP. Post-partum mothers are roomed on the same floor so they can more easily see their baby and feed. Assuming child is clinically well, antibiotics are stopped at 24-36h depending on biomarkers and the baby is transferred to the mother's room for remainder of stay.
2) We are studying the use of the Kaiser calculator, but there is lots of hesitancy about sending these babies directly to the normal nursery service as there is the perception (right or wrong) that a clinical decompensation in a baby would not be noticed by the normal nursery nurses in a timely manner. The other thing which is relevant for members of this forum is to understand that the Kaiser calculator is based on Likelihood ratios and knowledge of the background rate of neonatal sepsis in the population in question. While the calculator allows you to select a range of baseline risks, it is tuned (roughly) based on the US CDC baseline risk of 0.5/1000. If your local epidemiology is very different from the kaiser assumptions, the recommendations from the calculator may be wrong (disastrously so).
Although it seems more simple with one antibiotic, it may not be the best strategy, for reasons related to resistance development.
Carbapenems (like meropenem) are typically used as the treatment option when other antibiotics fails due to (known or assumed) resistance. So, depending on the bacteriological context, it may or may not be a reasonable 1st-line choice. And carbapenem resistance is worrysome thing for health care beyond the NICU.
So, a reasonable bottomline would be along the lines "If it works, don't fix it"
From the above , I like the idea of Dr johansson about giving only one antibiotic instead of keeping with 3 to 4 antibiotics; can we discuss using meropenem only for NEC?
Do we have infectious disease neonatologists in the team? I always feel like keeping meropenem for the next step , but using 4 antibiotics is not the best option even if most of us are doing so . What do you think?