Clinical Indicators of Late-Onset Sepsis Workup in Very Low-Birth-Weight Infants in the Neonatal Intensive Care Unit

Abstract

Background Late-onset sepsis (LOS) in very low-birth-weight (VLBW) infants is associated with significant morbidity and mortality. Objectives To determine the incidence of LOS workup, association, and predictive value of clinical indicators leading to culture-positive versus culture-negative sepsis workup. Methods All sepsis workups performed after 7 days of life, in neonates with birth weight of < 1,500 g were included. Each case (culture-positive workup) was matched with a control (culture-negative workup) for gestational age (GA), birth weight, corrected gestational age, and chronological age, at the time of workup. The clinical indicators leading to the performance of sepsis workup were compared between cases and controls. Results The incidence of culture-positive workup was 87/345 (25.2%) and that of LOS was 84/279 (30.1%). Among various clinical indicators, hypothermia and apnea were significantly associated with culture-positive sepsis workup (p = 0.015 and 0.004, respectively), with a positive predictive value of 81.2 and 71.4%, respectively. Conclusion In VLBW infants, one-fourth of sepsis workups resulted in a positive culture. Apnea and hypothermia were the most significant predictors of culture-positive workup after matching for GA, birth weight, chronological age, and corrected GA at the time of the workup.

Vital signs analysis algorithm detects inflammatory response in premature infants with late onset sepsis and necrotizing enterocolitis

“…In a subsequent study, Fairchild and colleagues reported a cross-correlation between heart rate and oxygen saturation, demonstrating the potential for other vital signs to improve HRC index monitoring for detection of LOS(29). There is evidence that acute increases in apnea, bradycardia, and desaturation episodes are some of the most common signs of LOS in preterm infants in the NICU(30). Thus, incorporation of multiple vital signs, including episodes of bradycardia and desaturations, as indicators of the pathophysiologic response to acute systemic inflammatory response is logical and innovative.…”

Vital signs and their cross-correlation in sepsis and NEC: a study of 1,065 very-low-birth-weight infants in two NICUs

“…High cross correlation of HR-SpO 2 may reflect apnea in infants who are not on mechanical ventilation. An acute increase in central apnea is one of the most common signs of late-onset septicemia in preterm infants in the NICU( 15 ), and apnea is often accompanied by both bradycardia and oxygen desaturation. Periodic breathing, alternating brief apneic pauses and breaths, is normal in neonates and sometimes associated with decline in HR and SpO 2 .…”

Framework for Considering Abnormal Heart Rate Characteristics and Other Signs of Sepsis in Very Low Birth Weight Infants

“…Many other groups have identified similar vital sign and clinical changes to those we found associated with clinical or culture-proven late-onset sepsis in VLBW infants. [21][22][23][24][25] These studies describe what experienced clinicians generally know and have incorporated into a mental framework for considering when to perform a sepsis work-up. Our primary objective in developing NeoSEP-10 was to codify this framework into an evaluation tool for all NICU clinicians to use when faced with a high-risk patient with changing clinical status that might be due to infection.…”

“…Funding NIH grant HD072071. 22 [18][19][20][21][22][23][24][25][26] 17 [12][13][14][15][16][17][18][19] 14 [11][12][13][14][15][16] 2…”

“…18 [16][17][18][19][20][21] 14 [11][12][13][14][15][16] 11 [9][10][11][12][13][14][15][16] 3 (6) 24 [18][19][20][21][22][23][24][25][26] 15 [11][12][13][14][15][16][17] 14 [11][12][13][14][15][16] Diagnoses:…”