Weber Martin W, Carlin John B, Gatchalian Salvacion, Lehmann Deborah, Muhe Lulu, Mulholland E Kim
Medical Research Council Laboratories, Fajara, The Gambia.
Pediatr Infect Dis J. 2003 Aug;22(8):711-7. doi: 10.1097/01.inf.0000078163.80807.88.
Neonatal infections are a major cause of death worldwide. Simple procedures for identifying infants with infection that need referral for treatment are therefore of major public health importance.
We investigated 3303 infants <2 months of age presenting with illness to health facilities in Ethiopia, The Gambia, Papua New Guinea and The Philippines, using a standardized approach. Historical factors and clinical signs predicting sepsis, meningitis, hypoxemia, deaths and an ordinal scale indicating severe disease were investigated by logistic regression, and the performance of simple combination rules was explored.
In multivariable analysis, reduced feeding ability, no spontaneous movement, temperature >38 degrees C, being drowsy/unconscious, a history of a feeding problem, history of change in activity, being agitated, the presence of lower chest wall indrawing, respiratory rate >60 breaths/min, grunting, cyanosis, a history of convulsions, a bulging fontanel and slow digital capillary refill were independent predictors of severe disease. The presence of any 1 of these 14 signs had a sensitivity for severe disease (defined as sepsis, meningitis, hypoxemia, or radiologically proven pneumonia) of 87% and a specificity of 54%. More stringent combinations, such as demanding 2 signs from the list, resulted in a considerable loss of sensitivity. By contrast only slight loss of sensitivity and considerable gain of specificity resulted from reducing the list to 9 signs. Requiring the presence of fever and any other sign produced a diagnostic rule with extremely low sensitivity (25%).
Physical signs can be used to identify young infants at risk of severe disease, however with limited specificity, resulting in large numbers of unnecessary referrals. Further studies are required to validate and refine the prediction of severe disease, especially in the first week of life, but there appear to be limits on the accuracy of prediction that is achievable.
新生儿感染是全球范围内主要的死亡原因。因此，用于识别需要转诊治疗的感染婴儿的简单方法具有重大的公共卫生意义。
我们采用标准化方法，对埃塞俄比亚、冈比亚、巴布亚新几内亚和菲律宾的卫生机构中3303名2个月以下患病婴儿进行了调查。通过逻辑回归研究了预测败血症、脑膜炎、低氧血症、死亡的历史因素和临床体征以及表示严重疾病的序数量表，并探讨了简单组合规则的性能。
在多变量分析中，喂养能力下降、无自主运动、体温>38摄氏度、嗜睡/昏迷、有喂养问题史、活动改变史、烦躁不安、下胸壁内陷、呼吸频率>60次/分钟、呻吟、发绀、惊厥史、囟门膨出和指端毛细血管再充盈缓慢是严重疾病的独立预测因素。这14种体征中任何一种的存在对严重疾病（定义为败血症、脑膜炎、低氧血症或经放射学证实的肺炎）的敏感性为87%，特异性为54%。更严格的组合，如从列表中要求2种体征，会导致敏感性大幅下降。相比之下，将列表减少到9种体征只会导致敏感性略有下降，而特异性大幅提高。要求同时存在发热和任何其他体征会产生敏感性极低（25%）的诊断规则。
体征可用于识别有严重疾病风险的幼儿，但其特异性有限，导致大量不必要的转诊。需要进一步研究来验证和完善严重疾病的预测，尤其是在生命的第一周，但似乎可实现的预测准确性存在局限性。
