Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis

Sokou, Rozeta; Ioakeimidis, Georgios; Piovani, Daniele; Parastatidou, Stavroula; Konstantinidi, Aikaterini; Tsantes, Andreas G.; Lampridou, Maria; Houhoula, Dimitra; Iacovidou, Nicoletta; Kokoris, Styliani; Vaiopoulos, Aristeidis G.; Gialeraki, Argyri; Kopterides, Petros; Bonovas, Stefanos; Tsantes, Argirios Ε.

doi:10.3389/fped.2022.1004727

Cited by 17 publications

(27 citation statements)

References 70 publications

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“…[88][89][90][91][92] As to sick neonates, few studies report on sepsis, bleeding risk, IVH, cardiac surgery, and therapeutic hypothermia after asphyxia. 87,[93][94][95][96][97][98][99][100][101][102][103][104][105][106] The only ROTEM study 76 concerning FGR infants did not identify any difference in ROTEM parameters between SGA and AGA, but more studies referring to the IUGR population are needed to confirm this statement.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature

Karapati

Sokou

Iliodromiti

et al. 2023

Semin Thromb Hemost

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Intrauterine growth restriction (IUGR) affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement. Both thrombotic and hemorrhagic events are described in the perinatal period in these neonates. The aim of this study was to systematically review the literature on the laboratory studies used to evaluate the hemostatic system of the IUGR small for gestational age neonate. We reviewed the current literature via PubMed and Scopus until September 2022. Following our inclusion/exclusion criteria, we finally included 60 studies in our review. Thrombocytopenia, characterized as hyporegenerative and a kinetic upshot of reduced platelet production due to in utero chronic hypoxia, was the main finding of most studies focusing on growth-restricted neonates, in most cases is mild and usually resolves spontaneously with the first 2 weeks of life. In regard to coagulation, growth-restricted newborns present with prolonged standard coagulation tests. Data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting, mainly due to confounding factors. As thromboelastography/rotational thromboelastometry (TEG/ROTEM) provides a more precise evaluation of the in vivo coagulation process compared with standard coagulation tests, its use in transfusion guidance is fundamental. Only one study regarding TEG/ROTEM was retrieved from this population, where no difference in ROTEM parameters compared with appropriate for gestational age neonates was found. Despite the laboratory aberrations, no correlation could be achieved with clinical manifestations of bleeding or thrombosis in the studies included. More studies are needed to assess hemostasis in IUGR neonates and guide targeted therapeutic interventions.

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Section: Discussionmentioning

confidence: 99%

Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature

Karapati

Sokou

Iliodromiti

et al. 2023

Semin Thromb Hemost

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“…43,63,64 Reflecting the functional potential of platelets more accurately compared to platelet count, viscoelastic tests provide a comprehensive assessment of neonatal hemostatic profile leading to a more precise prediction of the risk of hemorrhage in critically ill neonates. [65][66][67][68] Along these lines, Sokou et al 2 developed a prediction model evaluating, besides maternal risk factors, neonatal demographics, clinical and laboratory parameters used in the previous predicting models, and ROTEM variables. It is of note that clinical variables were not identified as strong predictors of hemorrhage risk in critically ill neonates and were not included in NeoBRis.…”

Section: Discussionmentioning

confidence: 99%

“…43 63 64 Reflecting the functional potential of platelets more accurately compared to platelet count, viscoelastic tests provide a comprehensive assessment of neonatal hemostatic profile leading to a more precise prediction of the risk of hemorrhage in critically ill neonates. 65 66 67 68…”

Section: Discussionmentioning

confidence: 99%

Bleeding Scoring Systems in Neonates: A Systematic Review

Sokou,

Parastatidou,

Konstantinidi

et al. 2023

Semin Thromb Hemost

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We conducted a systematic review aiming to summarize the data on the current hemorrhage prediction models and evaluate their potential for generalized application in the neonatal population. The electronic databases PubMed and Scopus were searched, up to September 20, 2023, for studies that focused on development and/or validation of a prediction model for bleeding risk in neonates, and described the process of model building. Nineteen studies fulfilled the inclusion criteria for the present review. Eighteen bleeding risk prediction models in the neonatal population were identified, four of which were internally validated, one temporally and one externally validated. The existing prediction models for neonatal hemorrhage are mostly based on clinical variables and do not take into account the clinical course and hemostatic profile of the neonates. Most studies aimed at predicting the risk of intraventricular hemorrhage (IVH) reflecting the fact that IVH is the most frequent and serious bleeding complication in preterm neonates. A justification for the study sample size for developing the prediction model was given only by one study. Prediction and stratification of risk of hemorrhage in neonates is yet to be optimized. To this end, qualitative standards for model development need to be further improved. The assessment of the risk of bleeding incorporating platelet count, coagulation parameters, and a set of relevant clinical variables is crucial. Large, rigorous, collaborative cohort studies are warranted to develop a robust prediction model to inform the need for transfusion, which is a fundamental step towards personalized transfusion therapy in neonates.

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“…Sepsis was defined as the clinical condition characterized by: A positive blood and/or cerebrospinal fluid (CSF) culture with bacteria or fungi. The presence of clinical signs of sepsis and a positive urine culture in neonates >72 h of life 7,8 …”

Section: Methodsmentioning

confidence: 99%

Thromboelastometry and prediction of in‐hospital mortality in neonates with sepsis

Sokou,

Tsantes,

Lampridou

et al. 2023

Int J Lab Hematology

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IntroductionThis study aimed at evaluating the role of rotational thromboelastometry (ROTEM) assays in the prediction of in‐hospital mortality of neonates with sepsis.MethodsOver a 6‐year period, 129 neonates with confirmed sepsis, hospitalized in our neonatal intensive care unit (NICU) were included in the study. Demographics, clinical, and laboratory data were recorded at the sepsis onset and ROTEM assays were performed. Modified neonatal multiple organ dysfunction (NEOMOD) and neonatal sequential organ failure assessment (nSOFA) were calculated simultaneously. Mortality during in‐hospital stay was the main outcome measure.ResultsIn‐hospital mortality was associated with patient intense hypocoagulability expressed by lower ROTEM MCF in the INTEM assay. The INTEM MCF demonstrated the best prognostic performance for NICU mortality in septic neonates among the other ROTEM parameters but without statistical significance (area under the curve [AUC] = 0.731; 95% confidence interval [CI]: 0.593–0.869).ConclusionOur results indicate that ROTEM INTEM MCF parameter has good predictive capacity for in‐hospital mortality of septic neonates, similar to that of modified NEOMOD score, nSOFA score, and platelet count, highlighting the integral role of coagulation in sepsis pathophysiology. Hence, ROTEM could serve as a valuable monitoring tool to identify neonates at risk.

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Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis

Cited by 17 publications

References 70 publications

Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature

Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature

Bleeding Scoring Systems in Neonates: A Systematic Review

Thromboelastometry and prediction of in‐hospital mortality in neonates with sepsis

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