Sepsis Screen Parameters in Blood Culture Positive Neonatal Sepsis

V. Sah, S. Yadav, A. Giri, S. Singh
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Abstract

Background: Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first 28 days of life. Although, Positive blood culture is the gold standard for the diagnosis of neonatal septicemia, definitive culture results take at least 48–72 h, resulting in treatment delay. Hence certain rapid diagnostic tests such as C-reactive protein, micro erythrocyte sedimentation rate, total white blood cell count, absolute neutrophil count, and immature/total neutrophil count ratio collectively termed as the “Sepsis Screen” is used. The aim of this research is to study the relation between sepsis screen parameters and blood culture proven neonatal sepsis and to assess the clinical profile of neonates with culture-proven sepsis. Materials and Methods: This was a descriptive observational study conducted on 97 clinically suspected neonatal sepsis cases in the neonatal intensive care unit.. Sepsis screen tests were evaluated for sensitivity, specificity, positive predictive value and negative predictive value. The culture results were correlated with sepsis screen tests and p-value<0.05 was considered significant.  Results: Early-onset sepsis was seen in 47.4% cases, while late-onset sepsis accounted for 52.6% cases. Immature to total neutrophil ratio was the single best reliable sepsis screen test with a high specificity, PPV, and negative predictive values of 93.8%, 85.7%, and 88.4% respectively. Conclusion: Most of the individual sepsis screen parameters showed statistical correlation with blood culture status, yet Immature to total neutrophil ratio had highest sensitivity, specificity, positive predictive value and proved to be a sensitive and responsive indicator of neonatal sepsis.
血培养阳性新生儿脓毒症筛查参数
背景:新生儿脓毒症是一种细菌血症的临床综合征,其特征是在生命的前28天出现全身感染体征和症状。虽然血培养阳性是诊断新生儿败血症的金标准,但明确的培养结果至少需要48-72小时,从而导致治疗延误。因此,使用一些快速诊断试验,如c反应蛋白、微红细胞沉降率、白细胞总数、绝对中性粒细胞计数和未成熟/总中性粒细胞计数比,统称为“败血症筛查”。本研究的目的是研究脓毒症筛查参数与血培养证实的新生儿脓毒症之间的关系,并评估培养证实的新生儿脓毒症的临床概况。材料与方法:对新生儿重症监护病房97例临床疑似新生儿脓毒症患者进行描述性观察性研究。评估脓毒症筛查试验的敏感性、特异性、阳性预测值和阴性预测值。培养结果与脓毒症筛查相关,p值<0.05被认为是显著的。结果:早发性脓毒症占47.4%,晚发性脓毒症占52.6%。未成熟中性粒细胞与总中性粒细胞的比值是唯一最可靠的脓毒症筛查试验,其特异性、PPV和阴性预测值分别为93.8%、85.7%和88.4%。结论:多数脓毒症单项筛查参数与血培养状态有统计学相关性,其中未成熟与总中性粒细胞比值敏感性、特异性最高,具有阳性预测价值,是新生儿脓毒症的敏感反应指标。
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16 weeks
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