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Can we improve early identification of neonatal late-onset sepsis? A validated prediction model

Journal of Perinatology volume 40, pages 1315–1322 (2020)Cite this article

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Abstract

Objective

No single test can accurately identify neonatal late-onset sepsis (LOS). Our aim was to use clinical evaluation with laboratory tests to rapidly assess sepsis risk.

Study design

A retrospective case-control study was performed in a tertiary Neonatal Center during the years 2016–2019. Infants with bacteriologically confirmed LOS were compared with control infants. A clinical health evaluation score was assigned to each infant. A prediction model was developed and validated by multivariable analysis.

Results

The study included 145 infants, 48 with sepsis, and 97 controls. LOS was independently associated with: sick appearance (OR: 5.7, 95% CI: 1.1–29.1), C-reactive protein > 0.75 (OR: 5.4, 95% CI: 1.1–26.3), and neutrophil-to-lymphocyte ratio > 1.5 (OR: 6.7, 95% CI: 1.2–38.5). Our model had an area under the receiver operating characteristic curve of 0.92 (95% CI: 0.86–0.97).

Conclusions

Clinical evaluation with neutrophil-to-lymphocyte ratio and C-reactive protein can rapidly identify LOS enabling decreased health costs and antibiotic use.

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Fig. 1: Receiver operating curves optimal cut-off values for chosen sepsis markers.
Fig. 2: Comparison of receiver operating curves of developmental (2a) and validation (2b) cohorts.

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Author information

Author notes

  1. These authors contributed equally: Ori Goldberg, Nofar Amitai

Authors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ori Goldberg, Nofar Amitai, Gabriel Chodick, Reuben Bromiker, Oded Scheuerman, Haim Ben-Zvi & Gil Klinger

  2. Neonatal Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

    Ori Goldberg, Reuben Bromiker & Gil Klinger

  3. Pediatrics Department A, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

    Nofar Amitai

  4. Maccabi Institute of Health Services Research, Maccabi Health Care Services, Tel Aviv, Israel

    Gabriel Chodick

  5. Pediatrics Department B, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

    Oded Scheuerman

  6. Infectious Disease Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

    Oded Scheuerman

  7. Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel

    Haim Ben-Zvi

Authors
  1. Ori Goldberg
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  2. Nofar Amitai
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  5. Oded Scheuerman
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  7. Gil Klinger
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Contributions

OG: leading role in study design, data acquisition, analysis and interpretation, writing and revision of paper, approved the submitted paper. NA: leading role in study conception and design. Contributed to data acquisition and revision of paper, approved the submitted paper. GC: study conception and design, data analysis and interpretation, revision of paper, approved the submitted paper. RB: study conception and design, data acquisition and interpretation, critical revision of paper, approved the submitted paper. OS: study conception and design, data interpretation, critical revision of paper, approved the submitted paper. HBZ: study conception and design, data acquisition, approved the submitted paper. GK: leading role in all study aspects including: conception and design of study, data acquisition, analysis and interpretation, writing of paper, final approval of the submitted paper.

Corresponding author

Correspondence to Gil Klinger.

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Goldberg, O., Amitai, N., Chodick, G. et al. Can we improve early identification of neonatal late-onset sepsis? A validated prediction model. J Perinatol 40, 1315–1322 (2020). https://doi.org/10.1038/s41372-020-0649-6

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