Can we improve early identification of neonatal late-onset sepsis? A validated prediction model

• Published in: Journal of perinatology Vol. 40; no. 9; pp. 1315 - 1322
• Main Authors: Goldberg, Ori, Amitai, Nofar, Chodick, Gabriel, Bromiker, Reuben, Scheuerman, Oded, Ben-Zvi, Haim, Klinger, Gil
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.09.2020; Nature Publishing Group
• Subjects: 692/308/174; 692/53/2423; Antibiotics; C-reactive protein; Comparative analysis; Evaluation; Infants; Infants (Newborn); Infection; Laboratory tests; Lymphocytes; Medical care, Cost of; Medicine; Medicine & Public Health; Neonates; Neutrophils; Newborn babies; Pediatric Surgery; Pediatrics; Prediction models; Proteins; Sepsis
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-020-0649-6

Objective No single test can accurately identify neonatal late-onset sepsis (LOS). Our aim was to use clinical evaluation with laboratory tests to rapidly assess sepsis risk. Study design A retrospective case-control study was performed in a tertiary Neonatal Center during the years 2016–2019. Infants with bacteriologically confirmed LOS were compared with control infants. A clinical health evaluation score was assigned to each infant. A prediction model was developed and validated by multivariable analysis. Results The study included 145 infants, 48 with sepsis, and 97 controls. LOS was independently associated with: sick appearance (OR: 5.7, 95% CI: 1.1–29.1), C-reactive protein > 0.75 (OR: 5.4, 95% CI: 1.1–26.3), and neutrophil-to-lymphocyte ratio > 1.5 (OR: 6.7, 95% CI: 1.2–38.5). Our model had an area under the receiver operating characteristic curve of 0.92 (95% CI: 0.86–0.97). Conclusions Clinical evaluation with neutrophil-to-lymphocyte ratio and C-reactive protein can rapidly identify LOS enabling decreased health costs and antibiotic use.