Department of Pediatric Gastroenterology, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Neonatal Intensive Care Unit, Emma Children's Hospital, Vrije Universiteit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Pediatr Res. 2022 Aug;92(2):362-372. doi: 10.1038/s41390-021-01792-0. Epub 2021 Oct 28.
Peripheral blood culture (PBC) is considered the gold standard for diagnosis of neonatal early-onset sepsis (EOS), but its diagnostic value can be questioned. We aimed to systematically asses the diagnostic test accuracy (DTA) of umbilical cord blood culture (UCBC) for EOS.
A systematic literature search was performed in PubMed, Embase, Web of Science, and the Cochrane Library. Studies performing UCBC for the diagnosis of EOS were included.
A total of 1908 articles were screened of which 17 were included. Incidences of positive PBC and UCBC were low in all studies. There was a large heterogeneity in the consistency between positive PBC and UCBC outcomes. PBC had a pooled sensitivity of 20.4% (95% CI 0.0-40.9) and specificity of 100.0% (95% CI 100.0-100.0) compared to 42.6% (95% CI 12.7-72.4%) and 97.8% (95% CI 93.1-100.0) of UCBC for clinical EOS, defined as clinical sepsis regardless of PBC outcomes.
This systematic review shows that, compared to PBC, UCBC has higher sensitivity and comparable specificity for clinical EOS and might be considered as diagnostic test for EOS. Due to the limited number of studies, low incidences of EOS cases, and the imperfect reference standards for EOS, results should be interpreted cautiously.
This is the first systematic review and meta-analysis investigating the diagnostic test accuracy of umbilical cord blood culture for neonatal early-onset sepsis. Peripheral blood culture is considered the gold standard for diagnosis of neonatal early-onset sepsis, but its value for this specific diagnosis can be questioned. Umbilical cord blood culture has higher sensitivity and comparable specificity for diagnosis of neonatal early-onset sepsis compared to peripheral blood culture, circumventing the risk for iatrogenic anemia and consequently might be used as a diagnostic tool for early-onset sepsis. Quality of evidence was regarded as low due to imperfect diagnostic methods of neonatal early-onset sepsis.
外周血培养（PBC）被认为是诊断新生儿早发性败血症（EOS）的金标准，但它的诊断价值可能受到质疑。我们旨在系统评估脐带血培养（UCBC）对 EOS 的诊断测试准确性（DTA）。
在 PubMed、Embase、Web of Science 和 Cochrane 图书馆中进行了系统文献检索。纳入了进行 UCBC 以诊断 EOS 的研究。
共筛选了 1908 篇文章，其中纳入了 17 篇。所有研究中，PBC 和 UCBC 的阳性率均较低。PBC 与 UCBC 结果之间的一致性存在很大的异质性。与 PBC 相比，UCBC 的敏感性为 20.4%（95%CI 0.0-40.9），特异性为 100.0%（95%CI 100.0-100.0），而 UCBC 的敏感性为 42.6%（95%CI 12.7-72.4%）和特异性为 97.8%（95%CI 93.1-100.0）对于临床 EOS 的诊断，临床 EOS 定义为无论 PBC 结果如何的临床败血症。
本系统评价表明，与 PBC 相比，UCBC 对临床 EOS 的敏感性更高，特异性相当，可作为 EOS 的诊断检测方法。由于研究数量有限、EOS 病例发生率低以及 EOS 的参考标准不完美，结果应谨慎解释。
这是第一项调查脐带血培养对新生儿早发性败血症的诊断测试准确性的系统评价和荟萃分析。外周血培养被认为是诊断新生儿早发性败血症的金标准，但它在这一特定诊断中的价值可能受到质疑。与外周血培养相比，脐带血培养对新生儿早发性败血症的诊断具有更高的敏感性和相当的特异性，可避免医源性贫血的风险，因此可能被用作早发性败血症的诊断工具。由于新生儿早发性败血症的诊断方法不完善，证据质量被认为较低。
