neonatal: etiología y diagnóstico
J Pediatr 2000 May;67(5):337-8
Value of superficial cultures in diagnosing neonatal sepsis.
Shenoy S, Antony G, Shenoy UV
Department of Microbiology, University Medical Centre, Kasturba Medical
College, Mangalore, Karnataka.
This study was conducted to determine the value of superficial cultures in
the diagnosis of neonatal sepsis in our hospital. Sixty three babies,
younger than 2 weeks who were admitted with suspected sepsis were
investigated. A total of 369 cultures were obtained from these babies--252
(68.29%) superficial and 171 (31.70%) deep cultures. External ear canal
swab, umbilical cord swab and throat swab culture accounted for the
superficial cultures. Blood culture, cerebrospinal fluid culture and i.v.
catheter culture accounted for deep cultures. Of the 369 cultures, 225
(60.97%) were positive for pathogens, which included Staphylococcus
aureus, Klebsiella sp, Escherichia coli, Group B streptococcus and
Enterococcus fecalis. The yield of pathogenic organisms was higher for
superficial cultures (53.84%). All superficial cultures obtained during
the study on each patient were simultaneously compared with the deep
cultures by antimicrobial sensitivity method. The overall comparison
showed that the practice of superficial cultures could be useful to
predict the pathogenic organisms causing invasive disease.
JPMA J Pak Med Assoc 2000 Mar;50(3):94-8
Rapid identification of neonatal sepsis.
Anwer SK, Mustafa S
Department of Paediatrics, Abbasi Shaheed Hospital, Karachi.
OBJECTIVE: To achieve rapid identification of neonatal sepsis. SETTING:
Neonatal Intensive care unit (NICU) of a teaching hospital. METHOD: We
evaluated fifty neonates who were admitted with clinical features
suggesting sepsis or who had principal risk factors, e.g. Prematurity
(< 36 weeks), Low birth weight (< 2.5 kg), H/o maternal pyrexia or
prolonged rupture of membranes, birth asphyxia, unbooked cases or
instrumentation. Five tests, i.e., Total Leukocyte Count (T.L.C.),
Absolute Neutrophil Count, Immature/Total Neutrophil ratio (I.T. ratio),
Platelet count and C-Reactive protein were used for rapid diagnosis of
neonatal sepsis. RESULTS: C-reactive protein (C.R.P.) and absolute
Neutrophil count had a sensitivity of over 60% with a specificity of 50%.
White blood cell count had a specificity of 93% but a sensitivity of 14%.
CONCLUSION: None of the tests used alone were reliable, but when in
combination these five tests may help to diagnose sepsis within a few
hours. Also, if the tests show a high negative predictive value, the
neonate can be discharged early from the hospital, stopping the
antibiotics, thereby reducing the cost of treatment and anxiety of the
JPMA J Pak Med Assoc 2000 Mar;50(3):91-4
Neonatal sepsis: an etiological study.
Anwer SK, Mustafa S, Pariyani S, Ashraf S, Taufiq KM
Department of Paediatric, Abbasi Shaheed Hospital, Karachi.
OBJECTIVE: A periodic review of neonatal sepsis to asses any change in the
infecting organism. METHOD: A prospective study was conducted at HMC and
ASH, Karachi. The babies suspected to have or developed sepsis any time
during hospitalization were investigated to establish the diagnosis and
isolate the causative organism. Blood culture was taken at the time of
admission or when sepsis was suspected. RESULTS: Out of 109 episodes of
blood culture proven sepsis 68 presented as early onset (within 48 hours
of birth) and 41 as late onset sepsis (after 48 hours of birth). In early
onset group Gram -ve and Gram +ve organisms were almost equal, i.e. 33 and
35 respectively. Among the gram -ve organism most of the cases were due to
Klebsiella sp, and Enterococcus was the commonest Gram +ve organism. In
late onset group majority of infections were due to gram +ve organisms,
i.e. 30 out of 41. Staph. aureus and Staph. epidermidis were commonest.
The organisms were least sensitive to Ampicillin (< 20%) and highly
sensitive to Amikacin (90% to 100%), Cefotaxime was also seen as a good
choice of antibiotic with sensitivity of (84%-89%). CONCLUSION: Gram +ve
organisms were the main cause of neonatal sepsis. Klebsiella sp. is still
the commonest organism causing early onset sepsis. The data must be
periodically reviewed and antibiotic policy revised accordingly.
Indian J Pediatr 1998 Jan-Feb;65(1):63-78
Early diagnosis and treatment of neonatal sepsis.
Gerdes JS, Polin R
Department of Pediatrics, Children's Hospital of Philadelphia, University
of Pennsylvania School of Medicine, USA.
Perinatally acquired bacterial neonatal sepsis is a low incidence, high
risk disease with a relatively benign treatment. Accurate diagnosis is
difficult because there is no definitive diagnostic test; even blood
cultures have an unacceptably low sensitivity. Therefore, the clinician
must accept that a number of neonates who do not have the disease will
have treatment initiated for sepsis. In order to treat rapidly all infants
with sepsis and to minimize therapy for those without infection,
historical, clinical, and laboratory data can be used together in a
management approach to achieve optimal results. A systemized approach
using history, examination, sepsis screen laboratory tests, and cultures
is presented to guide clinical management.
Pediatrics 2000 Mar;105(3 Pt 1):523-7
Rapid detection of microorganisms in blood cultures of newborn infants
utilizing an automated blood culture system.
Garcia-Prats JA, Cooper TR, Schneider VF, Stager CE, Hansen TN
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030,
BACKGROUND: Neonatal sepsis is a low incidence, high-risk disease with
many sepsis work-ups performed to detect a single case. Seventy-two hours
of antibiotic therapy have been traditionally recommended pending negative
culture results. Improved culture media and new technology integrated into
blood culture systems could shorten incubation time required to detect
positive culture results. This would then change the length of antibiotic
therapy in the management of the newborn infant with suspected sepsis. In
addition, previous data supporting the 72-hour recommendation were
retrospectively acquired, utilized nonautomated systems, and reported in
an era with a different population of microorganisms cultured in special
care nurseries. OBJECTIVE: Evaluate the time of incubation to detect
positive blood cultures from newborn infants with suspected sepsis using a
computer-assisted, automated blood culture system, ESP (Trek Diagnostic
Systems, Inc, Westlake, OH). DESIGN: Prospective, observational study.
PATIENTS AND SETTING: All positive blood culture results that were
obtained from term and preterm newborn infants born from November 1993
through June 1997 at a publicly funded hospital with over 6000 live births
per year. METHODS: As positive blood culture results were identified, data
were prospectively obtained from the patient's medical record. The
computer algorithm in the automated blood culture system determined the
time to positivity. Time to positivity was determined for blood cultures
obtained before the initiation antimicrobial therapy and compared with
those cultures obtained after beginning therapy. Time to positivity was
also evaluated for clinically important Gram-positive and Gram-negative
bacteria and yeast. RESULTS: Four hundred fifty-five positive blood
culture results were obtained from 222 patients. Gram-positive organisms
accounted for 80% (366/455) of the positive culture results, Gram-negative
organisms accounted for 11% (48/455), and yeast for 9% (41/455). Virtually
all cultures growing clinically significant Gram-positive and
Gram-negative organisms were positive by 24 to 36 hours of incubation.
Cultures growing Staphylococcus epidermidis were virtually all positive
after 36 to 48 hours of incubation. Of cultures growing yeast, 88% (36/41)
were positive by 48 hours of incubation. There was no difference in time
to positivity in pretherapy or posttherapy obtained positive blood
cultures. Prenatally administered antibiotics did not affect time to
positivity in positive cultures drawn on the first day of life. In a
selected group of microorganisms that are the frequent cause of bacteremia
in term infants, 97% and 99% of cultures were positive by 24 to 36 hours
of incubation when only pretherapy cultures are evaluated. CONCLUSIONS:
The ESP blood culture system identified 77%, 89% and 94% of all
microorganisms at 24, 36, and 48 hours of incubation in aerobic cultures
obtained from both term and preterm infants. Introduction of antimicrobial
therapy did not affect time to positivity. Reducing duration of antibiotic
therapy to 24 to 36 hours should be considered in term, asymptomatic
newborn infants undergoing evaluation for suspected sepsis for maternal
indications. Confirmation of similar rapidity of detection using other
blood culture systems should be undertaken.
Eur J Obstet Gynecol Reprod Biol 1999 Aug;85(2):151-8
Risk factors associated with early-onset sepsis in premature infants.
Martius JA, Roos T, Gora B, Oehler MK, Schrod L, Papadopoulos T, Gross
Department of Obstetrics and Gynecology, University of Wuerzburg, Germany.
OBJECTIVE: To define perinatal factors associated with early-onset
neonatal sepsis. STUDY DESIGN: Maternal and neonatal variables were
analysed retrospectively in 343 infants born before 35 weeks using
univariate and multivariate statistical analysis. RESULTS: Logistic
regression analysis identified risk factors for probable neonatal sepsis:
gestational age at delivery (odds ratio 0.9, 95% confidence interval (CI)
0.91-0.96), premature rupture of the membranes (odds ratio 2.9, 95% CI
1.004-8.56), Apgar score after 1 min (odds ratio 0.7, 95% CI 0.53-0.96),
and histological chorioamnionitis and/or funisitis (odds ratio 4.1, 95% CI
1.36-12.12). There was a strong association between probable sepsis and
intracranial haemorrhage of the infant (odds ratio 4.3, 95% CI
1.07-17.40). Funisitis had a high specificity (91%) and positive
predictive value (82%) for the detection of neonatal sepsis < or =32
weeks. CONCLUSIONS: Independent obstetrical risk factors for early-onset
neonatal sepsis in premature infants may help to identify newborns who
benefit from maternal antibiotic prophylaxis before birth. The
histological examination of the umbilical cord can be used as an
additional diagnostic test to detect newborns at risk of infection.
Am J Obstet Gynecol 1999 Nov;181(5 Pt 1):1197-202
Incidence of intrapartum maternal risk factors for identifying neonates
for early-onset group B streptococcal sepsis: A prospective study.
Towers CV, Rumney PJ, Minkiewicz SF, Asrat T
University of California, Irvine, USA.
OBJECTIVE: In mid-1996 and early 1997, the Centers for Disease Control and
Prevention, The American College of Obstetricians and Gynecologists, and
the American Academy of Pediatrics all published guidelines outlining 2
potential strategies for the purpose of preventing neonatal sepsis caused
by group B Streptococcus. One of these approaches involves treating
pregnant women intrapartum with antibiotics if any of the following risk
factors develop: delivery at <37 weeks' gestation, membrane rupture for
>/=18 hours' duration, or temperature during labor of >/=38 degrees
C. However, to date there have been no population-based studies that have
ascertained the percentage of pregnant women eligible to receive
intrapartum antibiotic chemoprophylaxis if these risk factors were used.
Our objective was to perform a large patient-based study at >1
institution evaluating all deliveries for the presence of maternal risk
factors by using the definitions of the current guidelines. STUDY DESIGN:
A prospective cohort study was initiated in 1995 at 3 private community
hospitals and 1 private referral center. The study population was composed
of 5410 consecutively delivered patients from the 4 different hospitals.
Every pregnancy was analyzed for gestational age at delivery, duration of
membrane rupture, temperature during labor, and use of intrapartum
antibiotic chemoprophylaxis. RESULTS: Of the 5410 patients, a total of 455
(8. 4%) were delivered of their neonates before 37 weeks' gestation, 421
(7.8%) had rupture of membranes for at least 18 hours' duration, and 378
(7.0%) had an intrapartum temperature of >/=38 degrees C. Overall, 1071
pregnant women (19.8% of the population studied) had >/=1 of the
defined risk factors. CONCLUSIONS: These data suggest that, if the current
risk factor strategy is used, 19.8% of the delivering population would
potentially be candidates for intrapartum antibiotic chemoprophylaxis.
Acta Paediatr 1999 Aug;88(8):880-4
Contribution of interleukin-6 in distinguishing between mild
respiratory disease and neonatal sepsis in the newborn infant.
Kallman J, Ekholm L, Eriksson M, Malmstrom B, Schollin J
Department of Infectious Diseases, Vasteras Medical Centre Hospital,
The purpose of this study was to investigate if early samples of
interleukin-6 (IL-6) could distinguish early bacterial sepsis from
respiratory diseases in the newborn. IL-6 and C-reactive protein (CRP)
were measured at onset of symptoms in newborns evaluated for sepsis during
the first week of life. Five groups of children were investigated: proven
sepsis, clinical sepsis, respiratory distress syndrome (RDS), transient
tachypnoea of the newborn (TTN) and controls. IL-6 was also analysed at
the time when CRP was at its maximum level. The results showed that
initial IL-6 distinguished proven and clinical sepsis from TTN, but not
from RDS. Initial CRP was of no value for diagnosis. Our conclusion is
that early IL-6 makes it possible to avoid antibiotics in children with
TTN and contributes to the diagnosis of sepsis faster than CRP.
Acta Paediatr 1999 Jun;88(6):647-50
Evaluation of interleukin-6, tumour necrosis factor-alpha and
interleukin-1beta for early diagnosis of neonatal sepsis.
Silveira RC, Procianoy RS
Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto
Alegre, RS, Brazil.
The objective of this study was to assess the contribution of
interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and
interleukin-1beta (IL-1beta) to an early diagnosis of early-onset neonatal
sepsis. A cohort of 117 newborn infants delivered during a 1-y period had
IL-6, TNF-alpha and IL-1beta, blood and cerebrospinal fluid (CSF)
cultures, leucocyte and platelet count collected on the initial evaluation
of possible early-onset sepsis. They were divided into four groups: I,
positive blood and/or CSF cultures; II, probably infected with clinical
sepsis but negative cultures; III, same as group II but mother received
antibiotic antepartum; and IV, newborn infants that did not receive any
antibiotic therapy. There were no differences among the four groups with
respect to mean gestational ages and birthweights, median Apgar scores,
type of delivery, or number of newborn infants with leucocyte count
<5000 mm(-3) or >25000 mm(-3), platelet count <100000 mm(-3),
immature/total neutrophil ratio >0.2, absolute neutrophil count
<1000mm(-3) and median IL-1beta levels. Median IL-6 and TNF-alpha
levels were significantly higher in groups with patients with a diagnosis
of clinical sepsis than in controls. The optimal cut-off point was 32 pg
ml(-1) for IL-6 and 12 pg ml(-1) for TNF-alpha. The combination of both
provided a sensitivity of 98.5%. In conclusion, the combination of IL-6
and TNF-alpha is a highly sensitive marker of sepsis in the immediate
Comment in: Acta Paediatr 1999 Jun;88(6):585-6
Lancet 1999 May 22;353(9166):1798-9 [Texto
Interleukin-6 concentrations in neonatal sepsis.
Mehr S, Doyle L
Comment on: Lancet 1999 Jan 16;353(9148):239-40
J Matern Fetal Med 1999 May-Jun;8(3):88-94
Maternal chorioamnionitis and umbilical vein interleukin-6 levels for
identifying early neonatal sepsis.
Smulian JC, Vintzileos AM, Lai YL, Santiago J, Shen-Schwarz S, Campbell WA
Department of Obstetrics, Gynecology and Reproductive Sciences, University
of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical
School/Saint Peter's University Hospital, New Brunswick 08903-0591, USA.
OBJECTIVE: The purpose of this study was to determine whether elevated
levels of umbilical vein IL-6 would be a better marker for early neonatal
sepsis than the clinical signs of maternal chorioamnionitis. METHODS:
Patients delivering preterm because of spontaneous preterm labor or
premature rupture of the membranes were evaluated for clinical signs of
chorioamnionitis, which was defined as a temperature of > or =100.4
degrees F along with > or =2 of the following: significant maternal
tachycardia (> or = 120 bpm), fetal tachycardia (> or =160 bpm),
purulent discharge, uterine tenderness, and leukocytosis (WBC > or
=18,000 cells/mm3). Umbilical vein blood was assayed for interleukin-6. An
elevated interleukin-6 level was determined to be 25 pg/mL. Infants were
evaluated for evidence of early neonatal sepsis. The abilities of clinical
chorioamnionitis and interleukin-6 levels > or =25 pg/mL to predict
early neonatal sepsis were compared. RESULTS: There were 28 patients
delivering 14 (50%) neonates with evidence for early neonatal sepsis. The
incidence of suspected neonatal sepsis in women with and without clinical
chorioamnionitis was 6/10 (60%) vs. 8/18 (44.4%), P = 0.43. Using receiver
operator characteristic curves, the best cutoff for interleukin-6 was
found to be 25 pg/mL. The compared sensitivity, specificity, and positive
and negative predictive values of clinical chorioamnionitis vs.
interleukin-6 levels > or =25 pg/mL for predicting early neonatal
sepsis were 42.9% vs. 92.9%, 71.4% vs. 92.9%, 60% vs. 92.9%, and 55.6% vs.
92.9%, respectively. CONCLUSIONS: Elevated umbilical vein levels of
interleukin-6 predict those preterm infants with early sepsis better than
the presence of clinical chorioamnionitis.
Rev Invest Clin 1998 Nov-Dec;50(6):463-70
[Five year experience with neonatal sepsis in a pediatric center].
Zamora-Castorena S, Murguia-de-Sierra MT
Hospital Infantil de Mexico Federico Gomez, Mexico, D.F.
OBJECTIVE: To describe the etiologic agents, clinical findings and
hematologic changes associated to sepsis in patients admitted to the
Neonatal Intensive Care Unit at the Hospital Infantil de Mexico Federico
Gomez and to determine the frequency of normal CBC (Complete Blood Cell
Count) at diagnosis of sepsis. METHODS: A chart review of septic patients
hospitalized from January 1992 to December 1996 was done. RESULTS: 103
septic patients with 147 episodes of bacteremia were detected among 945
newborn admissions. The most common isolates in blood cultures were
grampositive cocci (55%). Clinical findings associated to sepsis were
non-specific. Premature infants presented apnea and jaundice more
frequently than term infants (p < 0.05). At diagnosis of sepsis, 19% of
premature infants had a normal CBC compared to 8% of term infants.
Leukopenia was a poor prognosis-related finding, i.e. seven out of 35
patients who died were leukopenic vs 1 of 68 survivors (p < 0.05).
Overall, mortality was 34%, but sepsis-related mortality was 13%.
CONCLUSIONS: The incidence of sepsis in our population was high with
grampositive cocci as the most common blood isolates. Clinical features
associated to sepsis were non-specific. A significant proportion of septic
preterm infants had normal CBC at diagnosis and leukopenia was a poor
prognosis sign. Mortality associated to sepsis was high.
Pediatrics 1999 Jan;103(1 Suppl E):360-73
The neonatal "sepsis work-up": personal reflections on the
development of an evidence-based approach toward newborn infections in a
managed care organization.
Kaiser Permanente Medical Care Program Division of Research, Perinatal
Research Unit, Oakland, California 94611, USA.
"Rule out sepsis" may be the most common discharge diagnosis
among infants admitted to the neonatal intensive care unit. Although the
frequency of sepsis, meningitis, and other confirmed bacterial infections
has remained constant (between 1 and 5/1000 live births) for many years,
the number of infants evaluated and treated is much higher. Each year in
the United States, as many as 600 000 infants experience at least one
evaluation for suspected bacterial infection during the birth
hospitalization. The number treated is estimated at 130 000 to 400 000 per
year. Despite massive overtreatment, delayed diagnosis still occurs. The
Kaiser Permanente Medical Care Program (KPMCP) considers developing and
implementing an evidence-based approach to "rule out sepsis," a
research and operational priority. To achieve these goals, it is essential
to consider two key aspects of the problem. First, it is important to
adopt a phenomenologic approach that takes clinicians' personal experience
into account. This must include reflection on those aspects of experience
often considered "irrational" or "subjective." Second,
incorporation of a phenomenologic approach needs to be tempered with sound
epidemiologic methods. If one considers these two aspects-physician
experience and sound epidemiology-it is clear that much of the existing
literature on "rule out sepsis" is of limited utility.
Consequently, the KPMCP has conducted its own studies. These are aimed at
characterizing the "sepsis work-up," developing electronic
datasets that would permit clinicians to simulate various strategies, and
developing techniques for ongoing electronic monitoring. This article
summarizes the approach taken by the KPMCP Division of Research. It
describes the results of a pilot study as well as the development and use
of a dedicated neonatology outcomes database, the Kaiser Permanente
Neonatal Minimum Data Set (NMDS). The NMDS database includes the Score for
Neonatal Acute Physiology and permits ongoing monitoring of sepsis
"work-ups" as well as confirmed cases of neonatal infection. The
article also describes how the experience from the pilot as well as the
NMDS was incorporated in the design of a much larger study on "rule
out sepsis." Finally, the article describes some important theoretic
issues affecting decision rule development and the use of computer
simulations in neonatology. These issues are 1) how one handles possible
overanalysis of a dataset; 2) how one handles data points that are
unstable (eg, the absolute neutrophil count, which can vary considerably
depending on age and sampling conditions); and 3) the limitations of
decision rules based on computer simulations.
Perinatol 1998 Mar-Apr;18(2):135-7
Placental blood sampling: an aid to the diagnosis of neonatal sepsis.
Herson VC, Block C, McLaughlin JC, Tetreault J, Eisenfeld LI, Krause
Department of Pediatrics, Connecticut Children's Medical Center, Hartford
OBJECTIVE: To determine the usefulness of placental blood cultures in
establishment of the diagnosis of early onset sepsis. STUDY DESIGN: Babies
born to mothers with suspected intraamniotic fluid infection had blood
cultures obtained from a branch of the umbilical vein on the fetal surface
of the placenta immediately after delivery. The babies at highest risk (n
= 35) had subsequent neonatal blood cultured from a peripheral vein (group
1), whereas 26 newborns at a lower risk did not (group 2). A group of 20
term babies born after uncomplicated labor and vaginal delivery or by
elective cesarean delivery served as control subjects. RESULTS: Placental
blood cultures were more often positive for pathogens in group 1 (7 of 35;
20%; 0.09 to 0.36) than in group 2 (0 of 26; 0 to 0.11) or control
subjects (0 of 20; 0 to 0.14; p < 0.02). Within group 1, placental
blood cultures were more often positive (7 of 35; 20%; 0.09 to 0.36) than
subsequent neonatal blood cultures (1 of 35; 3%; 0 to 0.15; p < 0.05).
Contaminants were cultured in 3 of 81 (4%; 01 to 0.11) placental samples
(all from group 1) compared with 1 of 35 (3%; 0 to 0.11) neonatal samples
(difference not significant). CONCLUSIONS: A carefully obtained culture of
placental blood may be a useful addition or substitute for neonatal blood
culturing in newborns at risk for early-onset sepsis by virtue of maternal
Arch Dis Child Fetal Neonatal Ed 1997 Nov;77(3):F221-7
Diagnosis of late onset neonatal sepsis with cytokines, adhesion
molecule, and C-reactive protein in preterm very low birthweight infants.
Ng PC, Cheng SH, Chui KM, Fok TF, Wong MY, Wong W, Wong RP, Cheung KL
Department of Paediatrics, Prince of Wales Hospital, Chinese University of
Hong Kong, New Territories Hong Kong, People's Republic of China.
AIMS: To evaluate the commonly used markers--namely IL-6, TNF alpha, IL-1
beta, C-reactive protein and E-selection for identification of late onset
neonatal sepsis; to define the optimal cutoff value for each marker in
preterm neonates; to assess whether these markers could assist in early
discontinuation of antibiotics in non-infected cases; and to delineate the
profile of these markers during systemic infection and in relation to
successful treatment. METHODS: Very low birthweight infants in whom
clinical sepsis was suspected when they were > 72 hours of age were
eligible for study. A full sepsis screen was performed in each episode.
Cytokines, C-reactive protein, and E-selectin were serially
measured on days 0 (at the time of sepsis evaluation), 1, 2, 4 and
7. The optimal cutoff value for each marker was calculated after
minimising the number of misclassified episodes over all possible cutoff
values for days 0 and 1. The sensitivity, specificity, positive and
negative predictive values for each test and combination of tests for
predicting systemic infection were also determined. RESULTS: One hundred
and one episodes of suspected clinical sepsis were investigated in 68
infants. Forty five episodes were proved to be infections. The optimal
cutoff values were IL-6 31 pg/ml, TNF alpha 17 pg/ml, IL-1 beta 1 pg/ml, C
reactive protein 12 mg/l and E-selectin 174 ng/ml. IL-6 had the highest
sensitivity (89%) and negative predictive value (91%) for detecting late
onset infection on day 0. However, between 24 and 48 hours of onset,
C-reactive protein was the best single marker, with an overall sensitivity
and specificity of 84% and 96%, respectively. The use of serial and
multiple markers in the first 48 hours further enhanced the sensitivity
and specificity of these tests. Performing IL-6 and C-reactive protein on
day 0, together with either TNF alpha on day 1 or C-reactive protein on
day 2, showed the best overall sensitivity (98%) and specificity (91%) for
the diagnosis of late onset infection. CONCLUSIONS: Optimal cutoff values
for these markers in detecting late onset systemic infection in very low
birthweight infants have been defined. Withholding antibiotic treatment at
the onset of infection could be fatal and is not recommended, but the
concomitant use of IL-6 and C-reactive protein or TNF alpha should allow
antimicrobial treatment to be discontinued at 48 hours without waiting for
microbiological results, provided that the infants are in good clinical
Controlled clinical trial
Acta Paediatr 1997 Oct;86(10):1097-9
Rapid detection of neonatal sepsis using polymerase chain reaction.
Laforgia N, Coppola B, Carbone R, Grassi A, Mautone A, Iolascon A
Dipartimento di Biomedicina dell'Eta Evolutiva, Universita degli Studi,
Clinical diagnosis of sepsis in newborn infants is not easy and there is
no laboratory test with 100% specificity and sensitivity, with the
exception of blood culture, the results of which are not available for at
least 48-72 h. Polymerase chain reaction methodology has been used to
diagnose different bacterial, viral and protozoal infections, and the
possibility of amplifying the DNA region common to all bacteria could
represent an optimal method for the diagnosis of sepsis. The authors have
performed PCR in a group of 33 neonates at risk for early-onset sepsis,
correlating molecular data with blood culture results. The presence of
bacterial DNA in blood samples was evaluated, amplifying the DNA region
encoding the 16S rRNA. There were no false negative results (four positive
blood cultures and four positive PCR), with competitive costs and time.
This method also allows the diagnosis of sepsis due to uncommon species
and also, using a second PCR with specific primers, an aetiological
Acta Paediatr 1997 Sep;86(9):999-1002
The value of immunoglobulin and complement levels in the early
diagnosis of neonatal sepsis.
Kalayci AG, Adam B, Yilmazer F, Uysal S, Gurses N
Department of Paediatrics, Ondokuz Mayis University, School of Medicine,
Serum IgG, IgG1, G2, G3, G4, IgM, C3c and C4 concentrations were measured
in 24 term neonates with sepsis and 17 healthy normal neonates of similar
age, sex and weight (control group). The serum IgG, IgG1, G2, G3, G4, IgM,
C3c, and C4 levels were similar in the patients with sepsis and the
control group (p > 0.05). In the neonates with sepsis, serum IgG, G1,
G2, IgM and C4 levels were not significantly different between the 1st and
10th days, while there were significant differences for IgG3, G4 and C3c
(p < 0.05). We conclude that the serum levels of IgG, IgG1, G2, G3, G4,
IgM, C3c and C4 concentrations are of no value for the early diagnosis of
Pediatrics 1996 Jun;97(6 Pt 1):930; discussion 930-1
Lumbar puncture in the evaluation for early neonatal sepsis.
Beeram M, Oltorf C, Cipriani C
Comment on: Pediatrics 1995 Jun;95(6):803-6