University of Health Sciences, Izmir Faculty of Medicine, Dr. Behçet Uz Pediatric Diseases and Surgery Training Research Hospital, Child Health and Diseases Clinic, Izmir, Türkiye.
University of Health Sciences, Izmir Faculty of Medicine, Dr. Behçet Uz Pediatric Diseases and Surgery Training Research Hospital, Newborn Intensive Care Unit, İzmir, Türkiye.
J Neonatal Perinatal Med. 2024;17(5):661-671. doi: 10.3233/NPM-240011.
AİM: Late-onset neonatal sepsis has a high mortality rate in premature infants. To date, no single test in the evaluation of neonatal sepsis has been demonstrated to be both sensitive and specific enough to assist in timely decision making. The aim of our study is to develop a predictive model that can be applied to all premature babies, using clinical and laboratory findings in premature babies, to recognize late-onset neonatal sepsis.
STUDY DESİGN: 65 premature patients diagnosed with culture-proven late-onset neonatal sepsis and hospitalized in Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital neonatal intensive care unit between January 2018 and December 2020, and 65 premature newborns of similar age and gender who did not have sepsis were included in the study retrospectively.
In our study, feeding difficulties, worsening in clinical appearance and fever were found to be significant among clinical findings, while thrombocytopenia and high C-reactive protein among laboratory findings are the strongest data supporting late-onset neonatal sepsis. In multiple regression analysis, thrombocytopenia, mean platelet volume, C-reactive protein, lymphocyte count and feeding difficulties had the highest odds ratio (p < 0.05). By converting these data into a scoring system, a nomogram was created that can be easily used by all clinicians.
In our study, we developed a scoring system that can be easily applied to all premature patients by evaluating the clinical and laboratory findings in late-onset neonatal sepsis. We think that it will help in recognizing late-onset neonatal sepsis and strengthening the treatment decision. Predicting the individual probability of sepsis in preterm newborns may provide benefits for uninfected newborns to be exposed to less antibiotics, not to be separated from mother and baby, and to reduce healthcare system expenditures. The nomogram can be used to assess the likelihood of sepsis and guide treatment decision.
早产儿晚发性败血症的死亡率很高。迄今为止，在评估新生儿败血症的过程中，没有任何单一的检测方法能够既具有足够的敏感性又具有特异性，以帮助做出及时的决策。我们的研究目的是开发一种预测模型，该模型可以应用于所有早产儿，使用早产儿的临床和实验室发现来识别晚发性新生儿败血症。
回顾性纳入 2018 年 1 月至 2020 年 12 月期间在贝赫切特·乌兹儿科疾病和外科培训与研究医院新生儿重症监护病房被诊断为培养证实的晚发性新生儿败血症并住院的 65 例早产儿患者，以及 65 例年龄和性别相匹配的无败血症的早产儿作为对照。
在我们的研究中，临床发现中发现喂养困难、临床症状恶化和发热是显著的，而实验室发现中血小板减少和 C 反应蛋白升高是支持晚发性新生儿败血症的最强数据。在多变量回归分析中，血小板减少症、平均血小板体积、C 反应蛋白、淋巴细胞计数和喂养困难具有最高的优势比（p<0.05）。通过将这些数据转化为评分系统，创建了一个可以由所有临床医生轻松使用的诺模图。
在我们的研究中，我们通过评估晚发性新生儿败血症的临床和实验室发现，开发了一种评分系统，该系统可以很容易地应用于所有早产儿。我们认为，这将有助于识别晚发性新生儿败血症并加强治疗决策。预测早产儿个体发生败血症的概率可能有助于未感染的新生儿接触较少的抗生素，不与母亲和婴儿分离，并减少医疗保健系统的支出。诺模图可用于评估败血症的可能性并指导治疗决策。
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