James Jemila, Tewari Vishal Vishnu, Jain Naveen
Neonatal Intensive Care Unit, King Hamad University Hospital, Al Muharraq, Kingdom of Bahrain.
Department of Pediatrics, Command Hospital (SC) and Armed Forces Medical College, Pune, India.
Mediterr J Hematol Infect Dis. 2021 Mar 1;13(1):e2021019. doi: 10.4084/MJHID.2021.019. eCollection 2021.
Antibiotic therapy is initiated in neonates on suspicion of sepsis. Optimizing therapy is a felt need of clinicians as prolonged injudicious use increases mortality and morbidity risk.
To evaluate the diagnostic accuracy of clinical tool 'STOPS' and serum procalcitonin (PCT) for identifying neonates with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) and early discontinuation in those with no sepsis.
The study had a prospective analytical design conducted at a tertiary care hospital. Consecutively admitted neonates with suspected EONS or LONS were enrolled. The 'STOPS' tool comprising sensorium, temperature, oxygenation, perfusion, skin color, and blood sugar was applied at 6 and 12 hours of enrollment. Serum PCT was sent at 12 hr. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) were estimated.
The study enrolled 380 neonates, of which 330 were given antibiotics for EONS and 50 for LONS. Temperature disturbance in the EONS group at 12 hr showed a PPV of 100% and a PLR of 9.1 (7.7 - 18). Perfusion assessment at 12 hr had a PPV of 77% and PLR of 8.25 (2.3 - 29). Skin color assessment at 12 hr had a PPV of 100% and PLR of 13.5 (9.7 - 27). The diagnostic accuracy of PCT in the EONS group was unremarkable. In the LONS group, skin color at 12 hr had a PPV of 100% and PLR of 11.2 (8.6 - 19.5). The diagnostic accuracy of PCT in the LONS group showed a PPV of 82% and PLR of 7 (1.7 - 29).
Identifying abnormal STOPS parameters was superior to PCT alone in EONS and as good as PCT in LONS. The 'STOPS' tool allows early identification of neonates with no sepsis, thereby optimizing antibiotic use.
当怀疑新生儿患有败血症时即开始抗生素治疗。由于长期不合理使用会增加死亡率和发病风险，优化治疗是临床医生迫切的需求。
评估临床工具“STOPS”和血清降钙素原（PCT）对识别早发型新生儿败血症（EONS）或晚发型新生儿败血症（LONS）新生儿以及对无败血症新生儿早期停用抗生素的诊断准确性。
本研究在一家三级医院进行前瞻性分析设计。连续纳入疑似EONS或LONS的新生儿。在入组后6小时和12小时应用包含意识、体温、氧合、灌注、肤色和血糖的“STOPS”工具。在12小时时送检血清PCT。估计敏感性、特异性、阳性和阴性预测值（PPV和NPV）、阳性和阴性似然比（PLR和NLR）。
该研究纳入了380例新生儿，其中330例因EONS接受抗生素治疗，50例因LONS接受抗生素治疗。EONS组在12小时时体温异常的PPV为100%，PLR为9.1（7.7 - 18）。12小时时灌注评估的PPV为77%，PLR为8.25（2.3 - 29）。12小时时肤色评估的PPV为100%，PLR为13.5（9.7 - 27）。PCT在EONS组的诊断准确性不显著。在LONS组，12小时时肤色的PPV为100%，PLR为11.2（8.6 - 19.5）。PCT在LONS组的诊断准确性显示PPV为82%，PLR为7（1.7 - 29）。
在EONS中，识别异常的STOPS参数优于单独使用PCT，在LONS中与PCT效果相当。“STOPS”工具可早期识别无败血症的新生儿，从而优化抗生素使用。
