Okascharoen C, Hui C, Cairnie J, Morris A M, Kirpalani H
Division of Infectious Disease and Clinical Epidemiology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Perinatol. 2007 Aug;27(8):496-501. doi: 10.1038/sj.jp.7211767. Epub 2007 Jun 14.
To prospectively validate performance of a prediction score for diagnosis of late-onset neonatal sepsis (LNS) in a new patient population.
Data were prospectively collected from March 2003 to May 2004. Newborns were enrolled if they were in the neonatal intensive care unit (NICU) between 2 and 90 days, and during the first episode of clinical sepsis suspected. LNS was defined as a positive blood or cerebrospinal fluid (CSF) culture, which became the criterion standard.
A total of 105 neonates were evaluated for sepsis. Demographic characteristics were as follows: (mean (s.d.)) were gestational age (GA) 29 (3) weeks; birth weight (BW) 1232 (620) g and postnatal age 17.5 day (12). Thirty-five (33%) neonates had LNS (35 positive blood cultures; 2 positive CSF). No significant differences in GA, BW, gender, age and central line utilization were found between LNS positive and LNS negative groups. Using a cut-off score of < or = 3, the score predicted positive culture with sensitivity of 0.97 (95% confidence interval 0.85, 0.99) and a negative likelihood ratio of 0.07. The discrimination and calibration ability of LNS score was acceptable.
A simple clinical decision rule previously developed to predict LNS performs equally in an independent population and NICU.
前瞻性验证一种预测评分在新患者群体中诊断迟发性新生儿败血症（LNS）的性能。
前瞻性收集2003年3月至2004年5月的数据。如果新生儿在2至90天期间在新生儿重症监护病房（NICU），且处于首次临床怀疑败血症发作期间，则纳入研究。LNS定义为血培养或脑脊液（CSF）培养阳性，这成为标准对照。
共对105例新生儿进行了败血症评估。人口统计学特征如下：（均值（标准差））胎龄（GA）为29（3）周；出生体重（BW）为1232（620）g，出生后年龄为17.5天（12）。35例（33%）新生儿患有LNS（35例血培养阳性；2例脑脊液阳性）。LNS阳性组和LNS阴性组在胎龄、出生体重、性别、年龄和中心静脉置管使用率方面未发现显著差异。使用截断分数≤3时，该评分预测培养阳性的敏感性为0.97（95%置信区间0.85，0.99），阴性似然比为0.07。LNS评分的鉴别和校准能力可接受。
先前制定的用于预测LNS的简单临床决策规则在独立人群和新生儿重症监护病房中表现相同。
