Department of Neonatology, CHU Rennes, Rennes University, Inserm-CIC 1414, F-35033 Rennes, France.
LTSI-UMR_S Inserm 1099, University of Rennes, F-35000 Rennes, France.
Int J Environ Res Public Health. 2021 Jan 20;18(3):882. doi: 10.3390/ijerph18030882.
The definition of late-onset bacterial sepsis (LOS) in very preterm infants is not unified. The objective was to assess the concordance of LOS diagnosis between experts in neonatal infection and international classifications and to evaluate the potential impact on heart rate variability and rate of "bronchopulmonary dysplasia or death".
A retrospective (2017-2020) multicenter study including hospitalized infants born before 31 weeks of gestation with intention to treat at least 5-days with antibiotics was performed. LOS was classified as "certain or probable" or "doubtful" independently by five experts and according to four international classifications with concordance assessed by Fleiss's kappa test.
LOS was suspected at seven days (IQR: 5-11) of life in 48 infants. Following expert classification, 36 of them (75%) were considered as "certain or probable" (kappa = 0.41). Following international classification, this number varied from 13 to 46 (kappa = -0.08). Using the expert classification, "bronchopulmonary dysplasia or death" occurred less frequently in the doubtful group (25% vs. 78%, < 0.001). Differences existed in HRV changes between the two groups.
The definition of LOS is not consensual with a low international and moderate inter-observer agreement. This affects the evaluation of associated organ dysfunction and prognosis.
极早产儿晚发型细菌败血症（LOS）的定义并不统一。本研究旨在评估新生儿感染专家与国际分类之间 LOS 诊断的一致性，并评估其对心率变异性和“支气管肺发育不良或死亡”发生率的潜在影响。
本回顾性（2017-2020 年）多中心研究纳入了胎龄小于 31 周且有至少 5 天抗生素治疗意向的住院婴儿。LOS 由五位专家独立地按照“确定或可能”或“可疑”进行分类，并根据四种国际分类进行分类，通过 Fleiss'kappa 检验评估一致性。
48 名婴儿在出生后 7 天（IQR：5-11）怀疑有 LOS。根据专家分类，其中 36 名（75%）被认为是“确定或可能”（kappa=0.41）。根据国际分类，这个数字从 13 到 46 不等（kappa=-0.08）。使用专家分类，可疑组“支气管肺发育不良或死亡”的发生率较低（25% vs. 78%，<0.001）。两组间 HRV 变化存在差异。
LOS 的定义没有共识，国际间和观察者间的一致性较低。这会影响对相关器官功能障碍和预后的评估。
