Baseline Illness Severity Does Not Alter Accuracy of Neonatal Sepsis Screen

ABSTRACT

We investigated the relationship between illness severity and accuracy of neonatal sepsis screen. Consecutive neonates with clinically suspected early onset sepsis (EOS) were enrolled and blood culture and sepsis screen [C-reactive protein, absolute neutrophil count, immature to total ratio (ITR) and microerythrocyte sedimentation rate] were performed. Exclusion criteria were prior antibiotic exposure, nonavailable reports, and contaminated cultures. Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE-II) was used to categorize neonates into “mild to moderate” (score ≤40) and “severe” (score >40) illness. Sepsis was defined as positive blood culture, and positive screen as ≥2 parameters positive. Of 125 subjects, 86 had mild to moderate and 39, severe illness. Twenty-eight (22%) subjects had sepsis. Sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratio of positive test, and likelihood ratio of negative test of the sepsis screen and screen parameters were similar between the two groups. The sensitivity of the screen was 37.5% and 25% for mild to moderate illness and severe illness, respectively. Only ITR values correlated with SNAPPE-II scores in patients with “sepsis” (rho 0.4; p = 0.036). The severity of underlying illness does not alter the performance of the sepsis screen in diagnosing culture-positive EOS.

KEYWORDS

Neonate - sepsis - severity - SNAPPE

REFERENCES

• 1 Stoll B J, Hansen N, Fanaroff A A et al.. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network.  Pediatrics. 2002;  110(2 Pt 1) 285-291
• 2 Escobar G J. The neonatal “sepsis work-up”: personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization.  Pediatrics. 1999;  103(1 Suppl E) 360-373
• 3 Escobar G J, Li D K, Armstrong M A et al.. Neonatal sepsis workups in infants >/=2000 grams at birth: a population-based study.  Pediatrics. 2000;  106(2 Pt 1) 256-263
• 4 Philip A G, Hewitt J R. Early diagnosis of neonatal sepsis.  Pediatrics. 1980;  65 1036-1041
• 5 Gerdes J S. Clinicopathologic approach to the diagnosis of neonatal sepsis.  Clin Perinatol. 1991;  18 361-381
• 6 Schouten-Van Meeteren N Y, Rietveld A, Moolenaar A J, Van Bel F. Influence of perinatal conditions on C-reactive protein production.  J Pediatr. 1992;  120(4 Pt 1) 621-624
• 7 The WHO Young Infants Study Group . Clinical prediction of serious bacterial infections in young infants in developing countries.  Pediatr Infect Dis J. 1999;  18(10 Suppl) S23-S31
• 8 Fowlie P W, 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
• 9 Da Silva O, Ohlsson A, Kenyon C. Accuracy of leukocyte indices and C-reactive protein for diagnosis of neonatal sepsis: a critical review.  Pediatr Infect Dis J. 1995;  14 362-366
• 10 National Neonatology Forum of India .National Neonatal Perinatal Database: Report for the year 2002–2003. New Delhi; Chetna Publishers 2005
• 11 Richardson D K, Corcoran J D, Escobar G J, Lee S K. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores.  J Pediatr. 2001;  138 92-100
• 12 Schelonka R L, Yoder B A, desJardins S E, Hall R B, Butler J. Peripheral leukocyte count and leukocyte indexes in healthy newborn term infants.  J Pediatr. 1994;  125 603-606
• 13 Mouzinho A, Rosenfeld C R, Sánchez P J, Risser R. Revised reference ranges for circulating neutrophils in very-low-birth-weight neonates.  Pediatrics. 1994;  94 76-82
• 14 Singh S A, Dutta S, Narang A. Predictive clinical scores for diagnosis of late onset neonatal septicemia.  J Trop Pediatr. 2003;  49 235-239
• 15 Richardson D K, Gray J E, McCormick M C, Workman K, Goldmann D A. Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care.  Pediatrics. 1993;  91 617-623
• 16 Chiesa C, Pellegrini G, Panero A et al.. C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection.  Clin Chem. 2003;  49 60-68
• 17 Benitz W E, Han M Y, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection.  Pediatrics. 1998;  102 E41
• 18 Berger C, Uehlinger J, Ghelfi D, Blau N, Fanconi S. Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia.  Eur J Pediatr. 1995;  154 138-144