Section of Neonatology, Service of Pediatrics, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain.
J Perinat Med. 2012 Apr 22;40(5):571-6. doi: 10.1515/jpm-2011-0269.
We assessed central-peripheral temperature gradient alteration for the diagnosis of late-onset neonatal sepsis and compared earliness detection of this sign with altered blood cell count and C-reactive protein.
Thirty-one preterm babies (<1500 g or <32 weeks) participated in an observational prospective study. Axillary (central) and sole (peripheral) temperatures were continuously monitored with a thermal probe (ThermoTracer; Dräger Medical AGF & Co. KgaA, Lübeck, Germany) adjusting incubator air temperature for a thermal gradient <1.5°C. Central-peripheral temperature alteration was defined as a thermal gradient >2°C that could not be corrected with protocolized air temperature modifications. Proven (positive blood culture) sepsis and probable late-onset sepsis were recorded.
Late-onset sepsis was diagnosed in 11 neonates (proven, 9; probable, 2). Thermal gradient alteration was present in 12 cases, in association with the onset of sepsis in 10 and concomitantly with a ductus arteriosus and stage 1 necrotizing enterocolitis in 2. Thermal gradient alteration had a sensitivity of 90.9% [95% confidence interval (CI), 62.3-98.4] and specificity of 90% (95% CI, 69.9-97.2%), and in 80% of cases, it occurred before abnormal laboratory findings.
Central-peripheral temperature gradient monitoring is a feasible, non-invasive, and simple tool easily applicable in daily practice. An increase of >2°C showed a high-sensitivity and specificity for the diagnosis of late-onset sepsis.
我们评估了中心-外周温度梯度改变在晚发性新生儿败血症诊断中的作用，并比较了该指标与白细胞计数和 C 反应蛋白改变在早期发现该疾病方面的作用。
31 例早产儿（体重<1500g 或胎龄<32 周）参与了一项前瞻性观察研究。使用热敏探头（ThermoTracer；德国吕贝克 Dräger Medical AGF & Co. KgaA）连续监测腋温（中心温度）和足底温度（外周温度），探头调节保温箱温度，使中心-外周温度梯度<1.5°C。中心-外周温度梯度改变定义为温度梯度>2°C，且不能通过协议化的温度调节来纠正。记录了明确（血培养阳性）败血症和可能的晚发性败血症。
11 例新生儿诊断为晚发性败血症（明确 9 例，可能 2 例）。12 例存在温度梯度改变，与败血症发病相关的有 10 例，与动脉导管未闭和 1 期坏死性小肠结肠炎相关的有 2 例。温度梯度改变的敏感性为 90.9%（95%可信区间，62.3-98.4），特异性为 90%（95%可信区间，69.9-97.2%），80%的病例在异常实验室发现之前出现该改变。
中心-外周温度梯度监测是一种可行、非侵入性和简单的工具，在日常实践中易于应用。温度梯度增加>2°C 对晚发性败血症的诊断具有较高的敏感性和特异性。
