Strategies to diagnose late neonatal sepsis
Keywords:
SEPSIS, NEWBORN
Abstract
Neonatal sepsis is a frequent and severe disease in hospitalized neonates that requires a prompt diagnosis in order to chose an adequate treatment.
The purpose of this paper is to assess clinical and paraclinical variables to establish diagnosis of late neonatal sepsis through likelihood ratio and probability post-test.
A retrospective study that included 47 neonates histories with clinical diagnosis of suspected sepsis. The studied variables were as follow: surgical history, progressive metabolic acidosis in patients with proper ventilation and hepatomegalia; hyperglycemia, and white blood cell and platelets count.
Sepsis was defined through the clinical information plus positive hemoculture. Likelihood ratio was calculated for both clinical information and positive hemoculture. Fagan’s nomogram was used to estimate accuracy of diagnosis when one of the variables was present.
It was found that for a sepsis prevalence in a 34% unit the studied variables improved sepsis probability. Surgical history, acidosis and leucopenia reached a probability of 62.6%; hepatomegalia 57%; hyperglycemia, leukocytosis and plateletopenia 45%.
A neonate with a suspected sepsis that presents any of the studied variables has a probability of at least 50% of having a sepsis, in which case an active response should be taken.
References
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7) Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungus sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004; 17(3): 638-80.
8) Kilpatrick L, Harris MC. Cytokines and inflamatory response in the fetus and neonate. In: Polin RA, Fox WW, Abman SH. Fetal and neonatal physiology. 3rd ed. Philadelphia: WB Saunders, 2004: 1555-72.
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10) Bonadio WA, Hennes H, Smith D, Ruffing R, Melzer-Lange M, Lye P, et al. Reliability of observation variables in distinguishing infectious outcome of febril young infants. Pediatr Infect Dis J 1993; 12(2): 111-4.
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13) Moyer VA, Kennedy KA. Understanding and using diagnostic tests. Clin Perinatol 2003; 30(2): 189-204.
14) Kellogg JA, Ferrentino FL, Goodstein MH, Liss J, Shapiro SL, Bankert DA. Frequency of low level bacteremiain infants from birth to two months of age. Pediatr Infect Dis J 1997; 16(4): 381-5.
15) Vecchio TJ. Predictive value of a single diagnostic testin unselected populations. N Engl J Med 1966; 274(21): 1171-3.
16) Altman DG. Practical Statistics for medical research. London: Chataman & Hall, 1995: 415.
17) Ingelfinger JA, Mosteller F, Thibodeau LA, Ware JH. Biostatistics in Clinical Medicine. New York: Macmillan, 1983: 1.
18) Katz MA. A probability graph describing the predictive value of highly sensitive diagnostic test. N Engl J Med 1974; 291(21): 1115-6.
19) Fagan TJ. Nomogram for Bayes’s Theorem. N Engl J Med 1975; 293(5): 257.
20) Motulsky H, Stannard P, Neubig R, Ploatt M, Pilkington J, Searle P. GraphPad Prism. Versión 2.0. San Diego: GraphPad Software, 1994.
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22) Fitzgerald MJ, Goto M, Myers TF, Zeller WP. Early metabolic effects of sepsisin the preterm infant: lactic acidosis and increased glucose requirement. J Pediatr 1992; 121(6): 951-5.
23) Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med 1992; 20(1): 80-93.
24) Gabay C, Kushner I. Acute-fase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340(6): 448-54.
25) Aoki N, Xing Z. Use of citokines in infection. Expert Opin Emerg Drugs 2004; 9(2): 223-36.
26) Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem 2004; 279(47): 48487-92.
27) Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr 1988; 112(5): 761-7.
28) Fowlie PW, Schmidt B. Diagnostic tests for bacterial infection from birth to 90 days: a sistematic review. Arch Dis Child Fetal Neonatal Ed 1998; 78(2): F92-8.
29) Wagle S, Grauaug A, Kohan R, Evans SF. C-reactive protein as a diagnostic tool of sepsis in very immature babies. J Paediatr Child Health 1994; 30(1): 40-4.
30) Ng PC, Cheng SH, Chui KM, Fok TF, Wong MY, Wong W, et al. Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1997; 77(3): F221-7.
31) NG PC, Li K, Wong RP, Chui KM, Wong E, Fok TF. Neutrophil CD64 expression: a sensitive diagnostic marker for late-onset nosocomial infection in very low birthweight infants. Pediatr Res 2002; 51(3): 296-303.
32) de-Bont ES, Martens A, van-Raan J, Samson G, Fetter WP, Okken A, et al. Diagnostic value of plasma levels of tumor necrosis factor á(TNF á) and interleukin-6(IL-6) in newborn with sepsis. Acta Paediatr 1994; 83(7): 696-9.
33) Küster H, Weiss M, Willeitner AE, Detlefsen S, Jeremias E, Zbojan J, et al. Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation. Lancet 1998; 352(9136): 1271-7.
34) Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998; 102(4): E 41.
35) Kawamura M, Nishida H. The usefulness of serial C-reactive protein measurement in managing neonatal infection. Acta Paediatr 1995: 84(1):10-3.
36) Jordan JA, Durso MB. Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia. J Clin Microbiol 2000; 38(7): 2574-8.
2) Stoll JB, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Late-onset sepsisin very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996; 129(1): 63-71.
3) Klein JO. Bacterial sepsis and meningitis. In: Remington and Klein. Infectious Diseases of the Fetus and Newborn Infants. 5th ed. Philadelphia: WB Saunders, 2001: 943-98.
4) Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. To tap or no to tap: high likelihood of meningitis without sepsis among very low birth weight infants. Pediatrics 2004; 113(5): 1181-6.
5) Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292(19): 2357-65.
6) Murphy DJ, Hope PL, Johnson A. Neonatal risk factors for cerebral palsy in very preterm babies: case-control study. BMJ 1997; 314(7078): 404-8.
7) Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungus sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004; 17(3): 638-80.
8) Kilpatrick L, Harris MC. Cytokines and inflamatory response in the fetus and neonate. In: Polin RA, Fox WW, Abman SH. Fetal and neonatal physiology. 3rd ed. Philadelphia: WB Saunders, 2004: 1555-72.
9) Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR, et al. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. Pediatr Infect Dis J 1998; 17(7): 593-8.
10) Bonadio WA, Hennes H, Smith D, Ruffing R, Melzer-Lange M, Lye P, et al. Reliability of observation variables in distinguishing infectious outcome of febril young infants. Pediatr Infect Dis J 1993; 12(2): 111-4.
11) Singh AS, Dutta S, Narang A. Predictive clinical scores for diagnosis of late onset neonatal septicemia. J Trop Pediatr 2003; 49(4): 235-9.
12) Gordon A, Isaacs D. Late-onset infection and the role of antibiotic prescribing policies. Curr Opin Infect Dis 2004; 17(3): 231-6.
13) Moyer VA, Kennedy KA. Understanding and using diagnostic tests. Clin Perinatol 2003; 30(2): 189-204.
14) Kellogg JA, Ferrentino FL, Goodstein MH, Liss J, Shapiro SL, Bankert DA. Frequency of low level bacteremiain infants from birth to two months of age. Pediatr Infect Dis J 1997; 16(4): 381-5.
15) Vecchio TJ. Predictive value of a single diagnostic testin unselected populations. N Engl J Med 1966; 274(21): 1171-3.
16) Altman DG. Practical Statistics for medical research. London: Chataman & Hall, 1995: 415.
17) Ingelfinger JA, Mosteller F, Thibodeau LA, Ware JH. Biostatistics in Clinical Medicine. New York: Macmillan, 1983: 1.
18) Katz MA. A probability graph describing the predictive value of highly sensitive diagnostic test. N Engl J Med 1974; 291(21): 1115-6.
19) Fagan TJ. Nomogram for Bayes’s Theorem. N Engl J Med 1975; 293(5): 257.
20) Motulsky H, Stannard P, Neubig R, Ploatt M, Pilkington J, Searle P. GraphPad Prism. Versión 2.0. San Diego: GraphPad Software, 1994.
21) Martell M, Fescina RH, Nieto F, Martínez G, Martínez M, Delgado L, et al. Introducción a la metodología de la investigación científica.2ª ed. Montevideo: Oficina del Libro FEFMUR, 2003: 121.
22) Fitzgerald MJ, Goto M, Myers TF, Zeller WP. Early metabolic effects of sepsisin the preterm infant: lactic acidosis and increased glucose requirement. J Pediatr 1992; 121(6): 951-5.
23) Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med 1992; 20(1): 80-93.
24) Gabay C, Kushner I. Acute-fase proteins and other systemic responses to inflammation. N Engl J Med 1999; 340(6): 448-54.
25) Aoki N, Xing Z. Use of citokines in infection. Expert Opin Emerg Drugs 2004; 9(2): 223-36.
26) Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem 2004; 279(47): 48487-92.
27) Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr 1988; 112(5): 761-7.
28) Fowlie PW, Schmidt B. Diagnostic tests for bacterial infection from birth to 90 days: a sistematic review. Arch Dis Child Fetal Neonatal Ed 1998; 78(2): F92-8.
29) Wagle S, Grauaug A, Kohan R, Evans SF. C-reactive protein as a diagnostic tool of sepsis in very immature babies. J Paediatr Child Health 1994; 30(1): 40-4.
30) Ng PC, Cheng SH, Chui KM, Fok TF, Wong MY, Wong W, et al. Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1997; 77(3): F221-7.
31) NG PC, Li K, Wong RP, Chui KM, Wong E, Fok TF. Neutrophil CD64 expression: a sensitive diagnostic marker for late-onset nosocomial infection in very low birthweight infants. Pediatr Res 2002; 51(3): 296-303.
32) de-Bont ES, Martens A, van-Raan J, Samson G, Fetter WP, Okken A, et al. Diagnostic value of plasma levels of tumor necrosis factor á(TNF á) and interleukin-6(IL-6) in newborn with sepsis. Acta Paediatr 1994; 83(7): 696-9.
33) Küster H, Weiss M, Willeitner AE, Detlefsen S, Jeremias E, Zbojan J, et al. Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation. Lancet 1998; 352(9136): 1271-7.
34) Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998; 102(4): E 41.
35) Kawamura M, Nishida H. The usefulness of serial C-reactive protein measurement in managing neonatal infection. Acta Paediatr 1995: 84(1):10-3.
36) Jordan JA, Durso MB. Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia. J Clin Microbiol 2000; 38(7): 2574-8.
Published
2005-12-30
How to Cite
1.
Perotti E, Cazales C, Martell M. Strategies to diagnose late neonatal sepsis. Rev. Méd. Urug. [Internet]. 2005Dec.30 [cited 2024Nov.17];21(4):314-20. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/796
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Original Articles
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