Prediction models for neonatal health care-associated sepsis: A meta-analysis

Verstraete, Evelien Hilde, Blot, Koen, Mahieu, Ludo, Vogelaers, Dirk and Blot, Stijn (2015) Prediction models for neonatal health care-associated sepsis: A meta-analysis. Pediatrics, 135 4: e1002-e1014. doi:10.1542/peds.2014-3226

Author Verstraete, Evelien Hilde
Blot, Koen
Mahieu, Ludo
Vogelaers, Dirk
Blot, Stijn
Title Prediction models for neonatal health care-associated sepsis: A meta-analysis
Journal name Pediatrics   Check publisher's open access policy
ISSN 1098-4275
Publication date 2015-04-01
Year available 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1542/peds.2014-3226
Volume 135
Issue 4
Start page e1002
End page e1014
Total pages 13
Place of publication Elk Grove Village,United States
Publisher American Academy of Pediatrics
Collection year 2016
Language eng
Formatted abstract
BACKGROUND AND OBJECTIVES: Blood culture is the gold standard to diagnose bloodstream infection but is usually time-consuming. Prediction models aim to facilitate early preliminary diagnosis and treatment. We systematically reviewed prediction models for health care–associated bloodstream infection (HABSI) in neonates, identified superior models, and pooled clinical predictors. Data sources: LibHub, PubMed, and Web of Science.

METHODS: The studies included designed prediction models for laboratory-confirmed HABSI or sepsis. The target population was a consecutive series of neonates with suspicion of sepsis hospitalized for ≥48 hours. Clinical predictors had to be recorded at time of or before culturing. Methodologic quality of the studies was assessed. Data extracted included population characteristics, total suspected and laboratory-confirmed episodes and definition, clinical parameter definitions and odds ratios, and diagnostic accuracy parameters.

RESULTS: The systematic search revealed 9 articles with 12 prediction models representing 1295 suspected and 434 laboratory-confirmed sepsis episodes. Models exhibit moderate-good methodologic quality, large pretest probability range, and insufficient diagnostic accuracy. Random effects meta-analysis showed that lethargy, pallor/mottling, total parenteral nutrition, lipid infusion, and postnatal corticosteroids were predictive for HABSI. Post hoc analysis with low-gestational-age neonates demonstrated that apnea/bradycardia, lethargy, pallor/mottling, and poor peripheral perfusion were predictive for HABSI. Limitations include clinical and statistical heterogeneity.

CONCLUSIONS: Prediction models should be considered as guidance rather than an absolute indicator because they all have limited diagnostic accuracy. Lethargy and pallor and/or mottling for all neonates as well as apnea and/or bradycardia and poor peripheral perfusion for very low birth weight neonates are the most powerful clinical signs. However, the clinical context of the neonate should always be considered.
Keyword sepsis
clinical markers
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2016 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 4 times in Scopus Article | Citations
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