Diagnosis of Neonatal Sepsis: A Clinical and Laboratory Challenge

Chiesa, Claudio; Panero, Alessandra; Osborn, John; Simonetti, Antonella; Pacifico, Lucia

doi:10.1373/clinchem.2003.025171

Cited by 215 publications

(184 citation statements)

References 92 publications

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“…8 In those studies, 16,17 LPB either had not been detected with a commercially available assay and/or values were pooled over the first 24 h. As in a study on preterm infants, 14 we did not find an influence of gender and mode of delivery, nor correlations to the 5 min APGAR score, or cord blood pH. Other perinatal confounders that might affect LBP in analogy to CRP 17 cannot be ruled out. Our noninfected group, however, certainly does not represent an ideal population, since neonates were not necessarily free of a history of maternal and intrapartum complications.…”

Section: Lbp Concentrations In Noninfected Neonatesmentioning

confidence: 60%

Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

et al. 2006

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Objectives: To investigate postnatal lipopolysaccharide-binding protein (LBP) kinetics in term neonates and to test its diagnostic accuracy for earlyonset bacterial infection (EOBI).Study design: A total of 99 neonates with clinical and serological signs of EOBI comprised the study group; 198 neonates with risk factors, but without EOBI, served as controls. LBP, C-reactive protein (CRP) and interleukin-8 (IL-8) were determined.Results: LBP in the noninfected group increased until 24 h after birth (P<0.05 vs 6 h). LBP and CRP correlated strongly in neonates with suspected EOBI (r ¼ 0.63). Although LBP reached a higher sensitivity than CRP 6 and 12 h after clinical suspicion (45 (24-68) and 79% (54-94) vs 9 (0-24) and 39% (17-64); P<0.05)), EOBI was most reliably detected by IL-8. Conclusion: LBP kinetics were age-dependent. LBP was not sufficiently sensitive in the prediction of EOBI.

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Section: Lbp Concentrations In Noninfected Neonatesmentioning

confidence: 60%

Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

et al. 2006

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“…66 However, most scoring systems are more applicable for their negative predictive value and consequently for discontinuation of antimicrobial therapy. 45,67,68 …”

Section: Sepsis Screening Panels/scoresmentioning

confidence: 99%

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

2013

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The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis, especially in very low-birth-weight (VLBW) preterm infants and by the absence of optimal diagnostic tests. Although growth of an organism from a sterile site is the "gold standard" for definitive diagnosis, it is not always possible to isolate a causative pathogen. Invasive infections can occur in seemingly asymptomatic neonates. Therefore, assessment of history and risk factors in combination with diagnostic tests are used to identify neonates who are more likely to be infected.The definitions of early onset sepsis (EOS) and late onset sepsis (LOS) are subject to subspecialist variation. Many investigators, including those who participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Network and the Vermont Oxford Network, define EOS by the onset of signs/symptoms and an associated positive culture at or before 72 hours of life. LOS is characterized by the onset of symptoms consistent with sepsis at greater than 72 hours of life. These classifications of EOS and LOS reflect the differing etiologies and proposed pathophysiology of pathogens commonly associated with the timing of Keywords ► neonatal sepsis ► invasive candidiasis ► epidemiology ► management AbstractIdentifying neonates with sepsis is complicated by variability in clinical presentation. The incidence of early onset sepsis (EOS) resulting from invasive group B streptococcal (GBS) infections has been notably reduced by the widespread delivery of intrapartum antibiotic prophylaxis. Rates of EOS attributable to non-GBS etiologies have remained constant, and ampicillin-resistant Escherichia coli has become more prevalent. Lateonset sepsis (LOS) attributable to gram-positive organisms including coagulase-negative Staphylococci and Staphylococcus aureus is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of LOS, especially among infants who receive broad-spectrum antimicrobial agents. Prophylactic fluconazole administration to very low-birth-weight (VLBW) neonates during the first 6 weeks of life prevents invasive candidiasis in neonatal intensive care units (NICU) with high rates of fungal infections. Targeted fluconazole prophylaxis may be beneficial in VLBW neonates who receive care in NICUs with lower rates of invasive fungal infections. Assessment of immune function, neutrophil markers, acute phase reactants, and utilization of sepsis screening scores may contribute to the management of sepsis. Maternal decolonization, antimicrobial stewardship, early enteral feeding, and optimal infection control practices are potential practical strategies for reducing the burden of neonatal sepsis.

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“…It may be classified as early-onset (EOM) and late-onset meningitis (LOM) according to the time of diagnosis [2][3][4][5]. Symptoms and clinical findings usually appear during the first week of life in EOM [2,[5][6][7][8]. Some authors define the disease that begins within the first three days as very early onset meningitis (VEOM) [8].…”

Section: Introductionmentioning

confidence: 99%

“…Some authors define the disease that begins within the first three days as very early onset meningitis (VEOM) [8]. Late-onset meningitis occurs between postnatal 8 th and 30 th days [2,[5][6][7][8]. Despite the advancements in neonatal intensive care units (NICU) and increased availability of antibacterial and supportive medications, neonatal meningitis is still a serious disease with high morbidity and mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis

Kavuncuoğlu

Gürsoy

Türel

et al. 2013

J Infect Dev Ctries

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Introduction: We aimed to determine the incidence, etiology, risk factors and outcome of bacterial meningitis in neonates. Methodology: Neonates who developed bacterial meningitis between 2003 and 2010 in a tertiary hospital in Turkey were included in the study. Patients born in our hospital were defined as Group 1 and patients referred from other centres were defined as Group 2. Patients with evidence of congenital infections or central nervous system malformations were excluded. Demographic features, delivery type, time of onset of meningitis, co-morbidities, clinical features, blood and cerebrospinal fluid (CSF) analysis, cranial sonographic findings, and outcome of patients were recorded. Results: The study comprised 325 meningitis cases identified from 38,023 hospitalised patients in the neonatology unit among 11,8091 live births. Mean gestational age, birth weight, and hospital stay were 36.8±3.7 weeks, 2.480±924 g, and 26±12.4 days, respectively. Almost half (48%) of the patients were diagnosed in the first seven postnatal days and 52% at 8-30 days after birth. CSF culture findings were positive in 59 (18%) patients (28 in Group 1 and 31 in Group 2). Gram-positive bacteria were the responsible agents in 30 (51%) patients, whereas 26 (44%) patients had Gram-negative bacterial meningitis and 3 (5%) had Candida meningitis. Gram-negative bacteria were predominant in Group 1 whereas Gram positive bacteria were predominant in Group 2. Transfontanel ultrasonography revealed pathologic findings in 17.5% of patients. The total mortality rate was 2.5%. Conclusion: This large-scale study provides essential information about the etiology, characteristics, and outcome of neonatal bacterial meningitis in Turkey.

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Diagnosis of Neonatal Sepsis: A Clinical and Laboratory Challenge

Cited by 215 publications

References 92 publications

Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis

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