External validation of bedside prediction score for diagnosis of late-onset neonatal sepsis

Abstract

Objective: To prospectively validate performance of a prediction score for diagnosis of late-onset neonatal sepsis (LNS) in a new patient population. Result: A total of 105 neonates were evaluated for sepsis. Demographic characteristics were as follows: (mean (s.d.)) were gestational age (GA) 29 (3) weeks; birth weight (BW) 1232 (620) g and postnatal age 17.5 day (12). Thirty-five (33%) neonates had LNS (35 positive blood cultures; 2 positive CSF). No significant differences in GA, BW, gender, age and central line utilization were found between LNS positive and LNS negative groups. Using a cut-off score of p3, the score predicted positive culture with sensitivity of 0.97 (95% confidence interval 0.85, 0.99) and a negative likelihood ratio of 0.07. The discrimination and calibration ability of LNS score was acceptable. Conclusion:A simple clinical decision rule previously developed to predict LNS performs equally in an independent population and NICU.

Nosocomial Sepsis Risk Score for Preterm Infants in Low-resource Settings

“…Furthermore, few of the LOS scores have been externally validated; those that have often rely on laboratory data (e.g. C-reactive protein, arterial blood gases, serial complete blood counts), which are not widely available or are too expensive for routine use in low-resource settings [9,[21][22][23]. Furthermore, scores that are not purely 'physiologically based' but incorporate therapeutic risk factor data, such as changes in mechanical ventilation, central catheterization or total parenteral nutrition, are not appropriate for settings that have limited to no access to such highly technical interventions [10,24].…”

Predictive Scores for Late-Onset Neonatal Sepsis as an Early Diagnostic and Antimicrobial Stewardship Tool: What Have We Done So Far?

“…In particular, in 2005, Okascharoen et al presented the first bedside scoring system for hospitalized neonates, after examining multiple variables associated with proven LOS [ 37 ]. In 2007, the same team presented an external validation of this scoring system [ 38 ]. Simultaneously, clinicians were asked to complete a questionnaire and rate the probability of true sepsis after obtaining basic laboratory results while they were not aware of the criteria of the LOS score.…”

“…Feeding intolerance, hypotonia, lethargy and fever were clinical signs highly predictive of NS. One study and its validation indicated UVC usage as a sensitive parameter [ 37 , 38 ]. Some studies pointed out fever as a significant symptom of NS [ 34 , 35 , 37 ].…”

Prediction Models for Neonatal Health Care–Associated Sepsis: A Meta-analysis

“…Figure 1 shows the results of the search strategy. The research period spanned from 1993 to 2007 with 3 western European, [27][28][29] 4 South Asian, [30][31][32][33] 1 Canadian, 34 and 1 Turkish study. 35 All researches were performed in level III settings of which one 33 was conducted in a low-resource level III hospital.…”

“…Three studies did not include all neonates with suspicion of sepsis in their research; selection was made for neonates with gestational age ,34 weeks 29,33 and for birth weight $1000 g and #2500 g. 32 One study 35 did not report information on patient characteristics but did focus on nosocomial sepsis in neonates on neonatal intensive care. Two studies were internal 34 and external validation studies 28 of their former developed prediction score study. Another 2 studies 32,33 are adapted external validation studies of Singh et al 30 …”