Early Diagnosis of Late-Onset Neonatal Sepsis Using a Sepsis Prediction Score

Abstract

Sepsis represents a common cause of morbidity in the Neonatal Intensive Care Unit (NICU). Our objective was to assess the value of clinical and laboratory parameters in predicting septicemia (positive blood culture) in NICU infants. In the first part of the present study (derivation cohort) we retrospectively reviewed the clinical files of 120 neonates with symptoms of suspected sepsis and identified clinical and laboratory parameters associated with proven sepsis on the day the blood culture was taken, as well as 24 h and 48 h earlier. These parameters were combined into a sepsis prediction score (SPS). Subsequently (validation study), we prospectively validated the performance of the SPS in a cohort of 145 neonates. The identified parameters were: temperature instability, platelet count < 150,000/mm3, feeding volume decrease > 20%, changes in blood glucose > 50%, CRP > 1 mg/dL, circulatory and respiratory deterioration. In the retrospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 82.54% sensitivity, 85.96% specificity, 5.88 PLR (Positive Likelihood Ratio), 0.20 NLR (Negative Likelihood Ratio), 86.67% PPV (Positive Predictive Value), 81.67% NPV (Negative Predictive Value) and 84.17% accuracy. In the prospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 76.60% sensitivity, 72.55% specificity, 2.79 PLR, 0.32 NLR, 83.72% PPV, 62.71% NPV and 75.17% accuracy. We concluded that this combination of clinical and laboratory parameters may assist in the prediction of septicemia in NICUs.

Early Diagnostic Markers of Late-Onset Neonatal Sepsis

“…Some proposals have been made, such as a Sepsis Prediction Score by Sofouli et al This is a retrospective study in Greece on 120 newborns with suspected sepsis, combining eight clinical and laboratory parameters such as temperature instability, feeding volume decrease, platelet count < 150,000/mm 3 , changes in blood glucose, CRP > 1 mg/dL, circulatory and respiratory deterioration. The scoring model was then validated prospectively on 145 infants [ 29 ]. The results were again inconclusive as a lot of septic infants reached very low scores.…”

The Role of Biomarkers and Correlated Conditions in the Diagnosis of Neonatal Sepsis

“…Efficient and early treatment is crucial for the outcome and prognosis in neonatal sepsis, these cases requiring frequent administration of empirically broadspectrum antibiotics [19]. Positive cultures (blood, urine, cerebrospinal fluid) are time-consuming with a low sensitivity method, but still remain the gold standard for diagnosis [20,21]. A higher perspective was given in the field by the use of biomarkers.…”

Insight Into Neonatal Sepsis: An Overview

“…EOS describes a vertically transmitted infection in the first three days of life (72 hours), and LOS is a horizontally transmitted infection (after 72 hours of life) commonly caused by a microorganism in hospital settings. Although some researchers consider seven days as a cutoff limit for differentiating EOS and LOS, most epidemiological studies recommend 72 hours as a reference [ 3 ]. Moreover, a third group, very late-onset neonatal sepsis (VLOS), has also been described by some as a third classification.…”