Prasad G Raghavendra, Subba Rao J V, Aziz Amtul, Rashmi T M
Department of Paediatric Surgery, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India.
Department of Anaesthesia, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India.
J Indian Assoc Pediatr Surg. 2017 Oct-Dec;22(4):211-216. doi: 10.4103/0971-9261.214455.
Quantification of surgical sepsis was never done beyond superficial, subfascial, and deep surgical site infection (SSI). Invasive surgical sepsis with systemic manifestation has not been tried to be quantified in general and pediatric surgery in particular. Hence, this attempts to develop a novel grading system to quantify neonatal surgical infections.
Predisposing factors, infection, response, and organ failure (PIRO) is being used in critical care institutions for medical sepsis; it was modified with neonate-specific surgical parameters. Authors have developed a grading of these parameters into Grade I, II, and III.
A blinded statistical test was performed and results were put to test. Extended Mantel-Haenszel Chi-square test validated linear relationship with grade and outcome, hospital stay, deep SSI, and organ dysfunction. Analysis of variance also showed the significant relationship of changing trends in grade and outcome. (1) Higher the grade indicated the probability of death. (2) Grade I patients had less duration of hospital stay compared to Grade II and III ( = 0.04). (3) The requirement of organ support and SSI were also more in Grade III. (4) Grade I patients had less increase in trends compared to Grade II and III (F = 4.86). Authors therefore feel Neo-PIRO seems to be the first scoring system that shows a linear relationship between scores and grade.
Neo-PIRO is a novel grading system with surgical neonate-specific parameters. Future versions to include molecular parameters, as well as parameters selected by regression analysis.
外科脓毒症的量化从未超出浅表、筋膜下和深部手术部位感染（SSI）的范畴。具有全身表现的侵袭性外科脓毒症，总体上以及在儿科手术中，尤其未曾尝试进行量化。因此，本研究试图开发一种新的分级系统来量化新生儿外科感染。
重症监护机构在医疗脓毒症中使用易患因素、感染、反应和器官功能衰竭（PIRO）；对其进行了修改，纳入了新生儿特有的手术参数。作者将这些参数分为I级、II级和III级。
进行了盲法统计检验并对结果进行了验证。扩展的Mantel-Haenszel卡方检验验证了分级与结局、住院时间、深部SSI和器官功能障碍之间的线性关系。方差分析也显示了分级变化趋势与结局之间的显著关系。（1）分级越高，死亡概率越高。（2）I级患者的住院时间比II级和III级患者短（P = 0.04）。（3）III级患者对器官支持的需求和SSI也更多。（4）I级患者的趋势增加幅度比II级和III级患者小（F = 4.86）。因此，作者认为新生儿PIRO似乎是首个显示评分与分级之间存在线性关系的评分系统。
新生儿PIRO是一种具有新生儿外科特定参数的新型分级系统。未来版本将纳入分子参数以及通过回归分析选择的参数。
