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Allen Fischer, MD

Neonatology, KP Walnut Creek


"I remember the thrill we felt the first time the calculator was used 500 times in just a month. Today the tool averages about 70,000 hits a month in the United States, Western Europe, and Australia.”

Ask research scientists what one of the biggest challenges is with research, and most will say that it’s translating findings in to practice. But in the case of Drs. Allen Fischer and Michael Kuzniewicz, researchers and neonatologists at KP Walnut Creek and San Francisco, their unique collaboration resulted in not only setting a new standard for medical practice, but also reducing antibiotic use.

Their groundbreaking work included developing an online neonatal calculator that estimates the risk of early onset sepsis (EOS), with the aim of keeping low-risk babies with their mothers, and reserving antibiotics for those newborns who truly need it.

In the past, babies would be admitted to neonatal intensive care units to rule out EOS whenever the mother had a temperature or chorioamnionitis, based on a 2010 Centers for Disease Control (CDC) screening and treatment algorithm. This approach resulted in 350 to 500 newborns being treated with antibiotics annually in the United States for every 1 newborn who actually had EOS.

Dr. Kuzniewicz was concerned about the negative effects of unnecessary antibiotic exposure, the separation of babies from their mothers, and interruption of breastfeeding. The Division of Research’s Perinatal Research Unit analyzed data from over 600,000 newborns. Their analysis produced the Neonatal EOS Calculator, a predictive model that incorporates findings from an infant’s clinical exam, provides the baby’s individual risk of sepsis, and guides antibiotic management.

Dr. Fischer operationalized these findings into actual clinical care by persuading his colleagues that the EOS calculator was grounded in science and safety. By 2015, it had been implemented in all KP Northern California medical centers. Since that time, the calculator has reduced the number of newborns exposed to antibiotics by 44% and has been just as effective at identifying EOS patients as the 2010 guideline.

The Neonatal EOS calculator was adopted in all KP regions, as well as nationally and internationally. In 2018, the American Academy of Pediatrics (AAP) endorsed the Neonatal EOS Calculator as a safe and effective tool for implementing antibiotic stewardship in babies.

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