Department of Pediatrics, Division of Neonatology, University of Virginia School of Medicine, Charlottesville, VA, USA.
University of Virginia Center for Advanced Medical Analytics, Charlottesville, VA, USA.
J Neonatal Perinatal Med. 2021;14(4):553-561. doi: 10.3233/NPM-200578.
In premature infants, clinical changes frequently occur due to sepsis or non-infectious conditions, and distinguishing between these is challenging. Baseline risk factors, vital signs, and clinical signs guide decisions to culture and start antibiotics. We sought to compare heart rate (HR) and oxygenation (SpO2) patterns as well as baseline variables and clinical signs prompting sepsis work-ups ultimately determined to be late-onset sepsis (LOS) and sepsis ruled out (SRO).
At three NICUs, we reviewed records of very low birth weight (VLBW) infants around their first sepsis work-up diagnosed as LOS or SRO. Clinical signs prompting the evaluation were determined from clinician documentation. HR-SpO2 data, when available, were analyzed for mean, standard deviation, skewness, kurtosis, and cross-correlation. We used LASSO and logistic regression to assess variable importance and associations with LOS compared to SRO.
We analyzed sepsis work-ups in 408 infants (173 LOS, 235 SRO). Compared to infants with SRO, those with LOS were of lower GA and BW, and more likely to have a central catheter and mechanical ventilation. Clinical signs cited more often in LOS included hypotension, acidosis, abdominal distension, lethargy, oliguria, and abnormal CBC or CRP(p < 0.05). HR-SpO2 data were available in 266 events. Cross-correlation HR-SpO2 before the event was associated with LOS after adjusting for GA, BW, and postnatal age. A model combining baseline, clinical and HR-SpO2 variables had AUC 0.821.
In VLBW infants at 3-NICUs, we describe the baseline, clinical, and HR-SpO2 variables associated with LOS versus SRO.
早产儿常因败血症或非感染性疾病而出现临床变化，因此鉴别这两种疾病具有挑战性。基线风险因素、生命体征和临床体征指导着是否进行培养和开始使用抗生素的决策。我们旨在比较心率（HR）和氧饱和度（SpO2）模式以及促使进行败血症检查的基线变量和临床体征，最终确定这些检查是因晚发性败血症（LOS）还是败血症排除（SRO）而进行。
在三家新生儿重症监护病房（NICU）中，我们回顾了被诊断为 LOS 或 SRO 的极低出生体重（VLBW）婴儿首次败血症检查的记录。促使进行评估的临床体征是从临床医生的记录中确定的。有 HR-SpO2 数据时，分析其平均值、标准差、偏度、峰度和互相关。我们使用 LASSO 和逻辑回归来评估变量的重要性，并与 SRO 相比评估与 LOS 的关联。
我们分析了 408 例婴儿的败血症检查（173 例 LOS，235 例 SRO）。与 SRO 患儿相比，LOS 患儿的胎龄和体重较低，更有可能有中央导管和机械通气。LOS 患儿更常出现的临床体征包括低血压、酸中毒、腹胀、嗜睡、少尿和异常的全血细胞计数或 C 反应蛋白（p<0.05）。有 266 个事件有 HR-SpO2 数据。在调整胎龄、体重和出生后年龄后，事件发生前 HR-SpO2 的互相关与 LOS 相关。结合基线、临床和 HR-SpO2 变量的模型 AUC 为 0.821。
在三家 NICU 的 VLBW 婴儿中，我们描述了与 LOS 与 SRO 相关的基线、临床和 HR-SpO2 变量。
