Ori Goldberg1,2, Nofar Amitai1,3, Gabriel Chodick1,4, Reuben Bromiker1,2, Oded Scheuerman1,5,6, Haim Ben-Zvi1,7, Gil Klinger8,9. 1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 3. Pediatrics Department A, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 4. Maccabi Institute of Health Services Research, Maccabi Health Care Services, Tel Aviv, Israel. 5. Pediatrics Department B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 6. Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 7. Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel. 8. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. gilkl@tauex.tau.ac.il. 9. Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. gilkl@tauex.tau.ac.il.
Abstract
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.
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.