Rían Hayes1, Jack Hartnett1, Gergana Semova1, Cian Murray1, Katherine Murphy1, Leah Carroll1, Helena Plapp1, Louise Hession1, Jonathan O'Toole1, Danielle McCollum1, Edna Roche1, Elinor Jenkins1, David Mockler2, Tim Hurley1,3, Matthew McGovern1,3, John Allen1,3,4, Judith Meehan1,4, Frans B Plötz5,6, Tobias Strunk7,8, Willem P de Boode9, Richard Polin10, James L Wynn11,12, Marina Degtyareva13, Helmut Küster14, Jan Janota15,16, Eric Giannoni17, Luregn J Schlapbach18,19,20, Fleur M Keij21, Irwin K M Reiss21, Joseph Bliss22, Joyce M Koenig23, Mark A Turner24, Christopher Gale25, Eleanor J Molloy26,27,28,29,30. 1. Discipline of Paediatrics, Trinity College Dublin, the University of Dublin & Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland. 2. John Stearne Medical Library, Trinity College Dublin, St. James' Hospital, Dublin, Ireland. 3. Trinity Translational Medicine Institute, St James Hospital, Dublin, Ireland. 4. Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland. 5. Department of Paediatrics, Tergooi Hospital, Blaricum, The Netherlands. 6. Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands. 7. Neonatal Health and Development, Telethon Kids Institute, Perth, WA, Australia. 8. Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, WA, Australia. 9. Radboud Institute for Health Sciences, Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands. 10. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Columbia University Medical Center, New York City, NY, USA. 11. Department of Pediatrics, University of Florida, Gainesville, FL, USA. 12. Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA. 13. Department of Neonatology, Pirogov Russian National Research Medical University, Moscow, Russia. 14. Neonatology, Clinic for Paediatric Cardiology, Intensive Care and Neonatology, University Medical Centre Göttingen, Göttingen, Germany. 15. Neonatal Unit, Department of Obstetrics and Gynecology, Motol University Hospital and Second Faculty of Medicine, Prague, Czech Republic. 16. Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic. 17. Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. 18. Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, Australia. 19. Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Australia. 20. Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland. 21. Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 22. Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, USA. 23. Division of Neonatology, Saint Louis University, Edward Doisy Research Center, St. Louis, MO, USA. 24. Institute of Translational Medicine, University of Liverpool, Centre for Women's Health Research, Liverpool Women's Hospital, Liverpool, UK. 25. Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster campus, Imperial College London, London, UK. 26. Discipline of Paediatrics, Trinity College Dublin, the University of Dublin & Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland. Eleanor.molloy@tcd.ie. 27. Trinity Translational Medicine Institute, St James Hospital, Dublin, Ireland. Eleanor.molloy@tcd.ie. 28. Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland. Eleanor.molloy@tcd.ie. 29. Paediatrics, Coombe Women's and Infant's University Hospital, Dublin, Ireland. Eleanor.molloy@tcd.ie. 30. Neonatology, CHI at Crumlin, Dublin, Ireland. Eleanor.molloy@tcd.ie.
Abstract
INTRODUCTION: Neonatal sepsis is a leading cause of infant mortality worldwide with non-specific and varied presentation. We aimed to catalogue the current definitions of neonatal sepsis in published randomised controlled trials (RCTs). METHOD: A systematic search of the Embase and Cochrane databases was performed for RCTs which explicitly stated a definition for neonatal sepsis. Definitions were sub-divided into five primary criteria for infection (culture, laboratory findings, clinical signs, radiological evidence and risk factors) and stratified by qualifiers (early/late-onset and likelihood of sepsis). RESULTS: Of 668 papers screened, 80 RCTs were included and 128 individual definitions identified. The single most common definition was neonatal sepsis defined by blood culture alone (n = 35), followed by culture and clinical signs (n = 29), and then laboratory tests/clinical signs (n = 25). Blood culture featured in 83 definitions, laboratory testing featured in 48 definitions while clinical signs and radiology featured in 80 and 8 definitions, respectively. DISCUSSION: A diverse range of definitions of neonatal sepsis are used and based on microbiological culture, laboratory tests and clinical signs in contrast to adult and paediatric sepsis which use organ dysfunction. An international consensus-based definition of neonatal sepsis could allow meta-analysis and translate results to improve outcomes.
INTRODUCTION: Neonatal sepsis is a leading cause of infant mortality worldwide with non-specific and varied presentation. We aimed to catalogue the current definitions of neonatal sepsis in published randomised controlled trials (RCTs). METHOD: A systematic search of the Embase and Cochrane databases was performed for RCTs which explicitly stated a definition for neonatal sepsis. Definitions were sub-divided into five primary criteria for infection (culture, laboratory findings, clinical signs, radiological evidence and risk factors) and stratified by qualifiers (early/late-onset and likelihood of sepsis). RESULTS: Of 668 papers screened, 80 RCTs were included and 128 individual definitions identified. The single most common definition was neonatal sepsis defined by blood culture alone (n = 35), followed by culture and clinical signs (n = 29), and then laboratory tests/clinical signs (n = 25). Blood culture featured in 83 definitions, laboratory testing featured in 48 definitions while clinical signs and radiology featured in 80 and 8 definitions, respectively. DISCUSSION: A diverse range of definitions of neonatal sepsis are used and based on microbiological culture, laboratory tests and clinical signs in contrast to adult and paediatric sepsis which use organ dysfunction. An international consensus-based definition of neonatal sepsis could allow meta-analysis and translate results to improve outcomes.
Authors: Christine Cole Johnson; Dennis R Ownby; Sharon Hensley Alford; Suzanne L Havstad; L Keoki Williams; Edward M Zoratti; Edward L Peterson; Christine L M Joseph Journal: J Allergy Clin Immunol Date: 2005-06 Impact factor: 10.793
Authors: Meike van der Ree; Jozien C Tanis; Koenraad N J A Van Braeckel; Arend F Bos; Elise Roze Journal: Early Hum Dev Date: 2011-07-14 Impact factor: 2.079
Authors: Mervyn Singer; Clifford S Deutschman; Christopher Warren Seymour; Manu Shankar-Hari; Djillali Annane; Michael Bauer; Rinaldo Bellomo; Gordon R Bernard; Jean-Daniel Chiche; Craig M Coopersmith; Richard S Hotchkiss; Mitchell M Levy; John C Marshall; Greg S Martin; Steven M Opal; Gordon D Rubenfeld; Tom van der Poll; Jean-Louis Vincent; Derek C Angus Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: Barbara J Stoll; Nellie Hansen; Avroy A Fanaroff; Linda L Wright; Waldemar A Carlo; Richard A Ehrenkranz; James A Lemons; Edward F Donovan; Ann R Stark; Jon E Tyson; William Oh; Charles R Bauer; Sheldon B Korones; Seetha Shankaran; Abbot R Laptook; David K Stevenson; Lu-Ann Papile; W Kenneth Poole Journal: Pediatrics Date: 2002-08 Impact factor: 7.124
Authors: Barbara J Stoll; Nellie I Hansen; Ira Adams-Chapman; Avroy A Fanaroff; Susan R Hintz; Betty Vohr; Rosemary D Higgins Journal: JAMA Date: 2004-11-17 Impact factor: 56.272