Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand
Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand
复制标题
DOI：
10.1186/s12879-020-4875-5
复制
发表时间：
2020-02-18
影响因子：
3.7
通讯作者：
Kaewkungwal, Jaranit
中科院分区：
文献类型：
--
作者：
Husada, Dominicus;Chanthavanich, Pornthep;Kaewkungwal, Jaranit
新生儿败血症的早期诊断是预防严重并发症和避免不必要的抗生素使用的关键。在许多国家，新生儿败血症的死亡率超过18%。本研究旨在建立细菌迟发性新生儿败血症的预测模型。方法在泰国曼谷西里吉王后国立儿童健康研究所进行病例对照研究。数据来源于52例脓毒症患者和156例非脓毒症对照组的病历。败血症组仅包括已证实的细菌性新生儿败血症病例。非败血症组为无任何感染的新生儿。潜在的预测因素包括风险因素、临床条件、实验室数据和治疗方式。模型建立在多元Logistic回归分析基础上。结果晚期确诊新生儿败血症发生率为1.46%。该模型有6个显著变量：摄食不良、心率异常(100~180x/min)、体温异常(36(O)~37.9℃)、血氧饱和度异常、白细胞异常(按Manroe‘s年龄标准)、pH异常(7.27~7.45)。受试者工作特征(ROC)曲线下面积为95.5%。评分的敏感性为88.5%，特异性为90.4%。结论建立了细菌迟发性败血症的预测模型和评分系统。这一更简单的工具有望在一定程度上取代微生物培养，特别是在资源有限的情况下。
BackgroundEarly diagnosis of neonatal sepsis is essential to prevent severe complications and avoid unnecessary use of antibiotics. The mortality of neonatal sepsis is over 18%in many countries. This study aimed to develop a predictive model for the diagnosis of bacterial late-onset neonatal sepsis.MethodsA case-control study was conducted at Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Data were derived from the medical records of 52 sepsis cases and 156 non-sepsis controls. Only proven bacterial neonatal sepsis cases were included in the sepsis group. The non-sepsis group consisted of neonates without any infection. Potential predictors consisted of risk factors, clinical conditions, laboratory data, and treatment modalities. The model was developed based on multiple logistic regression analysis.ResultsThe incidence of late proven neonatal sepsis was 1.46%. The model had 6 significant variables: poor feeding, abnormal heart rate (outside the range 100-180 x/min), abnormal temperature (outside the range 36(o)-37.9 degrees C), abnormal oxygen saturation, abnormal leucocytes (according to Manroe's criteria by age), and abnormal pH (outside the range 7.27-7.45). The area below the Receiver Operating Characteristics (ROC) curve was 95.5%. The score had a sensitivity of 88.5% and specificity of 90.4%.ConclusionA predictive model and a scoring system were developed for proven bacterial late-onset neonatal sepsis. This simpler tool is expected to somewhat replace microbiological culture, especially in resource-limited settings.