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

Journal of Perinatology volume 27, pages 496–501 (2007)Cite this article

Abstract

Objective:

To prospectively validate performance of a prediction score for diagnosis of late-onset neonatal sepsis (LNS) in a new patient population.

Study design:

Data were prospectively collected from March 2003 to May 2004. Newborns were enrolled if they were in the neonatal intensive care unit (NICU) between 2 and 90 days, and during the first episode of clinical sepsis suspected. LNS was defined as a positive blood or cerebrospinal fluid (CSF) culture, which became the criterion standard.

Results:

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 ⩽3, 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.

Conclusions:

A simple clinical decision rule previously developed to predict LNS performs equally in an independent population and NICU.

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References

  1. Fowlie PW, Schmidt B . Diagnostic tests for bacterial infection from birth to 90 days – a systematic review. Arch Dis Child Fetal Neonatal Ed 1998; 78: F92–F98.

    Article  CAS  Google Scholar 

  2. Malik A, Hui CP, Pennie RA, Kirpalani H . Beyond the complete blood cell count and C-reactive protein: a systematic review of modern diagnostic tests for neonatal sepsis. Arch Pediatr Adolesc Med 2003; 157: 511–516.

    Article  Google Scholar 

  3. 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: F221–F227.

    Article  CAS  Google Scholar 

  4. Vazzalwar R, Pina-Rodrigues E, Puppala BL, Angst DB, Schweig L . Procalcitonin as a screening test for late-onset sepsis in preterm very low birth weight infants. J Perinatol 2005; 25: 397–402.

    Article  CAS  Google Scholar 

  5. Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT . Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed 2005; 90: F220–F224.

    Article  CAS  Google Scholar 

  6. Okascharoen C, Sirinavin S, Thakkinstian A, Kitayaporn D, Supapanachart S . A bedside prediction-scoring model for late-onset neonatal sepsis. J Perinatol 2005; 25: 778–783.

    Article  Google Scholar 

  7. Laupacis A, Sekar N, Stiell IG . Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA 1997; 277: 488–494.

    Article  CAS  Google Scholar 

  8. Wasson JH, Sox HC, Neff RK, Goldman L . Clinical prediction rules. Applications and methodological standards. N Engl J Med 1985; 313: 793–799.

    Article  CAS  Google Scholar 

  9. Mahieu LM, De Dooy JJ, Cossey VR, Goossens LL, Vrancken SL, Jespers AY et al. Internal and external validation of the NOSEP prediction score for nosocomial sepsis in neonates. Crit Care Med 2002; 30: 1459–1466.

    Article  Google Scholar 

  10. Hanley JA, McNeil BJ . The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.

    Article  CAS  Google Scholar 

  11. Lemeshow S, Le Gall JR . Modeling the severity of illness of ICU patients. A systems update. JAMA 1994; 272: 1049–1055.

    Article  CAS  Google Scholar 

  12. Hui C, Cairnie J, Morri A, Smaill F, Kirpalani H . Prospective Study of Procalcitonin and Immature to Total Neutrophil Ratio in the Diagnosis of Nosocomial Neonatal Sepsis. In: AMMI Canada-CACMID 2005; Victoria, BC, Canada 2005.

  13. Lijmer JG, Mol BW, Heisterkamp S . Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999; 282: 1061–1066.

    Article  CAS  Google Scholar 

  14. Urrea M, Iriondo M, Thio M . A prospective incidence study of nosocomial infections in a neonatal care unit. Am J Infect Control 2003; 31: 505–507.

    Article  Google Scholar 

  15. Buttery JP . Blood cultures in newborns and children: optimising an everyday test. Arch Dis Child Fetal Neonatal Ed 2002; 87: F25–F28.

    Article  CAS  Google Scholar 

  16. Fischer JE . Physicians' ability to diagnose sepsis in newborns and critically ill children. Pediatr Crit Care Med 2005; 6: S120–S125.

    Article  Google Scholar 

  17. Jaeschke R, Guyatt GH, Sackett DL . Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The evidence-based medicine working group. JAMA 1994; 271: 703–707.

    Article  CAS  Google Scholar 

  18. Liossis G, Bardin C, Papageorgiou A . Comparison of risks from percutaneous central venous catheters and peripheral lines in infants of extremely low birth weight: a cohort controlled study of infants <1000 g. J Matern Fetal Neonatal Med 2003; 13: 171–174.

    Article  CAS  Google Scholar 

  19. Parellada JA, Moise AA, Hegemier S, Gest AL . Percutaneous central catheters and peripheral intravenous catheters have similar infection rates in very low birth weight infants. J Perinatol 1999; 19: 251–254.

    Article  CAS  Google Scholar 

  20. Hermansen MC, Hermansen MG . Intravascular catheter complications in the neonatal intensive care unit. Clin Perinatol 2005; 32: 141–156.

    Article  Google Scholar 

  21. O'Grady NP, Alexander M, Dellinger EP . Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, US. Pediatrics 2002; 110: e51.

    Article  Google Scholar 

  22. Butler-O'Hara M, Buzzard CJ, Reubens L . A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics 2006; 118: e25–e35.

    Article  Google Scholar 

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Acknowledgements

This study was funded by GlaxoSmithKline/Canadian Institutes of Health Research/Canadian Infectious Disease Society, Infectious Disease Research Fellowship (Hui), Hamilton Health Sciences Research Development Fund.

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Authors and Affiliations

  1. Division of Infectious Disease and Clinical Epidemiology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    C Okascharoen

  2. Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada

    C Hui

  3. Department of Nursing, McMaster University Medical Center, Hamilton, ON, Canada

    J Cairnie

  4. Divisions of Infectious Diseases and General Internal Medicine, Department of Medicine, Hamilton Health Sciences, Hamilton, ON, Canada

    A M Morris

  5. Department of Pediatrics and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

    H Kirpalani

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  1. C Okascharoen
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  2. C Hui
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  3. J Cairnie
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  4. A M Morris
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  5. H Kirpalani
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Corresponding author

Correspondence to H Kirpalani.

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Conflict of interest: None declared.

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Okascharoen, C., Hui, C., Cairnie, J. et al. External validation of bedside prediction score for diagnosis of late-onset neonatal sepsis. J Perinatol 27, 496–501 (2007). https://doi.org/10.1038/sj.jp.7211767

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