Goldberg Ori, Sokolover Nir, Bromiker Ruben, Amitai Nofar, Chodick Gabriel, Scheuerman Oded, Ben-Zvi Haim, Klinger Gil
Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Front Pediatr. 2021 Aug 19;9:693882. doi: 10.3389/fped.2021.693882. eCollection 2021.
Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48-72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables. Infants evaluated for late-onset sepsis during the years 2016-2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated. The study cohort was divided to a development cohort (105 patients) and a validation cohort (60 patients). At 24 h after initial evaluation, the best variables to identify sepsis were C-reactive protein > 0.75 mg/dl, neutrophil-to-lymphocyte ratio > 1.5 and sick-appearance at 24 h. Use of these 3 variables together with blood culture status at 24 h, enabled identification of all infants that eventually developed sepsis through the decision tree model. Our decision tree has an area under the receiver operating characteristic curve of 0.94 (95% CI: 0.90-0.98). In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, sepsis is highly unlikely and discontinuing antibiotics after 24 h is a viable option.
新生儿晚发型败血症检查在每个新生儿科室都很常见。血培养是诊断的金标准，然而，48 - 72小时前血培养阴性通常被认为不足以排除败血症。我们旨在开发一种决策树，能够利用临床和实验室变量在24小时内排除晚发型败血症。2016年至2019年期间在一家三级新生儿中心接受晚发型败血症评估、无严重畸形的婴儿符合纳入标准。在败血症检查后0小时和24小时提取血培养以及临床和实验室数据。将细菌学确诊的晚发型败血症婴儿与匹配的对照婴儿进行比较。单因素逻辑回归确定潜在风险因素。基于卡方自动交互检测方法开发并验证了一种决策树。研究队列分为一个开发队列（105例患者）和一个验证队列（60例患者）。在初始评估后24小时，识别败血症的最佳变量是C反应蛋白>0.75mg/dl、中性粒细胞与淋巴细胞比值>1.5以及24小时时的病态表现。将这3个变量与24小时时的血培养状态一起使用，通过决策树模型能够识别所有最终发生败血症的婴儿。我们的决策树在受试者工作特征曲线下的面积为0.94（95%CI：0.90 - 0.98）。对于24小时时血培养阴性且实验室值正常、无病态表现的婴儿，发生败血症的可能性极小，24小时后停用抗生素是一个可行的选择。
