Clinical

Simple clinical score predicts nosocomial sepsis in preterm neonates

Last Updated: 2009-08-26 18:10:24 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Bedside clinical signs including apnea, hepatomegaly, jaundice, lethargy and pallor indicate sepsis in hospitalized premature neonates and can be used as a clinical score in resource-poor settings, according to research from Bangladesh.

Sepsis is a leading cause of mortality for neonates in developing countries, researchers note in a report posted online in the Journal of Tropical Pediatrics. Most existing scores for neonatal sepsis include laboratory and ventilation parameters that may not be feasible in resource-poor settings, Dr. Rebecca Rosenberg and colleagues explain.

"Identifying sepsis, which often presents with nonspecific signs and symptoms in the preterm neonate, is challenging," note Dr. Rosenberg from the Department of International Health, Johns Hopkins University, and colleagues from Dhaka Children's Hospital, Bangladesh.

They evaluated a clinical sepsis risk score based on those five criteria, which were derived from an existing neonatal clinical score for sepsis that was not designed specifically for premature neonates.

The study included 497 hospitalized preterm neonates, aged 72 hours or less, who were born at 33 weeks gestation.

A total of 193 episodes of suspected sepsis in 160 neonates were evaluated with blood and cerebrospinal fluid culture examination resulting in a confirmed diagnosis in 105 episodes involving 98 infants. The clinical criteria were retrospectively applied in these neonates and compared with culture.

The presence of any one of these clinical criteria could predict sepsis with a sensitivity of 77.1%, specificity of 50%, and positive predictive value of 64.9%, the researchers report.

Using all five of the criteria resulted in a drop in sensitivity to 1%, but a specificity and positive predictive value of 100%, they add.

Respiratory distress -- used in other scoring systems -- was not discriminatory, being a common sign of prematurity, the researchers note.

"Our clinical sepsis score is the first bedside clinical screen exclusively for hospitalized, very premature neonates in a low-resource setting, and warrants external validation," Dr. Rosenberg's team concludes.

J Trop Pediatr 2009.