多中心新生儿医疗保健相关感染预测（NeoHoP）评分的外部验证：一项回顾性病例对照研究。

Multicentre external validation of the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score: a retrospective case-control study.

机构信息

Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, Western Cape, South Africa.

Faculty of Health Sciences, Paediatrics and Child Health, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa.

出版信息

BMJ Paediatr Open. 2024 Oct 1;8(1):e002748. doi: 10.1136/bmjpo-2024-002748.

DOI:10.1136/bmjpo-2024-002748

PMID:39353711

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11448137/

Abstract

BACKGROUND AND OBJECTIVES

Neonatal mortality due to severe bacterial infections is a pressing global issue, especially in low-middle-income countries (LMICs) with constrained healthcare resources. This study aims to validate the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score, designed for LMICs, across diverse neonatal populations.

METHODS

Prospective data from three South African neonatal units in the Neonatal Sepsis Observational (NeoOBS) study were analysed. The NeoHoP score, initially developed and validated internally in a South African hospital, was assessed using an external cohort of 573 sepsis episodes in 346 infants, focusing on different birth weight categories. Diagnostic metrics were evaluated, including sensitivity, specificity, positive predictive value and area under the receiver operating characteristic curve.

RESULTS

The external validation cohort displayed higher median birth weight and gestational age compared with the internal validation cohort. A significant proportion were born before reaching healthcare facilities, resulting in increased sepsis evaluation, and diagnosed healthcare-associated infections (HAIs). Gram-negative infections predominated, with fungal infections more common in the external validation cohort.The NeoHoP score demonstrated robust diagnostic performance, with 92% specificity, 65% sensitivity and a positive likelihood ratio of 7.73. Subgroup analysis for very low birth weight infants produced similar results. The score's generalisability across diverse neonatal populations was evident, showing comparable performance across different birth weight categories.

CONCLUSION

This multicentre validation confirms the NeoHoP score as a reliable 'rule-in' test for HAI in neonates, regardless of birth weight. Its potential as a valuable diagnostic tool in LMIC neonatal units addresses a critical gap in neonatal care in low-resource settings.

摘要

背景与目的

由于严重细菌感染导致的新生儿死亡是一个紧迫的全球性问题，尤其是在医疗资源有限的中低收入国家（LMICs）。本研究旨在验证为 LMICs 设计的新生儿医疗机构相关性感染预测（NeoHoP）评分在不同新生儿人群中的适用性。

方法

分析了来自南非新生儿败血症观察（NeoOBS）研究的三个南非新生儿病房的前瞻性数据。最初在南非一家医院内部开发和验证的 NeoHoP 评分，通过 346 名婴儿中 573 例败血症发作的外部队列进行评估，重点关注不同的出生体重类别。评估了诊断指标，包括敏感性、特异性、阳性预测值和受试者工作特征曲线下面积。

结果

外部验证队列的中位出生体重和胎龄均高于内部验证队列。很大一部分婴儿在到达医疗机构之前就已出生，导致更多的败血症评估和诊断为医疗机构相关性感染（HAIs）。革兰氏阴性感染为主，外部验证队列真菌感染更为常见。NeoHoP 评分表现出良好的诊断性能，特异性为 92%，敏感性为 65%，阳性似然比为 7.73。极低出生体重婴儿的亚组分析产生了类似的结果。该评分在不同新生儿人群中的通用性明显，在不同出生体重类别中表现出相似的性能。