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Background Neonatal sepsis remains a diagnostic challenge due to its nonspesific symptoms and signs. Blood culture as the gold standard is still a problem because it takes time, is expensive, and not every health facility is able to perionn.
Objective To evaluate the diagnostic accuracy of clinical symptoms, hematologic findings, and C-reactive protein (CRP) in neonatal sepsis.
Methods Samples were taken from potentially infected neonates admitted to the Matemal-Perinatal Unit of Sardjito Hospital, between December 1st, 2000 and March 31st, 2001 using at least one of the criteria: prematurity, very low birth weight infants, matemal pyrexia during delivery, premature membrane rupture, or thick, cloudy amniotic fluid. Clinical symptoms, total leukocyte, neutrophil, platelet count, CRP, and blood culture as the gold standard were examined.
Results Among 99 neonates enrolled, the sensitivity, specificity, positive and negative predictive value of clinical symptoms were 79.3%, 75.7%, 57.5%, and 89.9%, respectively; leukopenia/leukocytosis were 27.6%, 85.7%, 44.4%, and 74.1%; neutropenia! neutrophilia were 41.4%, 71.4%, 37.5%, and 74.6%; thrombocytopenia were 79.3%, 51.8%, 40.4%, and 85.7%; positive CRP were 58.6%,78.6%,53.1%, and 82.1%. Parallel tests increased the sensitivity up to 89.7%. Specificity, positive and negative predictive value, and likelihood ratio were 44.3%, 40%, 91.2%, and 1.6, respectively. Serial tests increased the specificity up to 88.6%. Sensitivity, positive and negative predictive value, and likelihood ratio were 58.6%, 68%, 83.8%, and 5.1, respectively.
Conclusion Clinical sepsis, thrombocytopenia, and CRP are sufficiently accurate as diagnostic tests for sepsis in potentially infected neonates. Parallel tests will increase the sensitivity, while serial tests increase the specificity.
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2. Philip AGS, Hewitt JR. Early diagnosis of neonaral sepsis. Pediatrics 1980;65:1036•41.
3. Liu CH, Lehan C, Speer ME. Fernbach OJ. Rudolph AJ. Degenerative changes in neucrophils: an indicator of bacterial infection, Pediatrics 1984;74:823-7.
4. Pourcyrons M, Bada HS, Korones SB, Baselski V, Wong SP. Significance of serial CRP responses in neonatal infection and other disorders. Pediatrics 1993;92:431-5.
5. Harris MC, Cortarino AI; Sulivan JS, Dulkerian S, Mc Cavky L, Corcoran L. Cytokine elevations in critically ill infants with sepsis and necrotizing enterocolitis. J Pediatr 1994; 124:105-11.
6. Schuchat A. Zywichi SS. Dinsmoor M, Mercer B. Romaquera J, O'Sullivan MJ, et al. Risk factors and opportunities for prevention of early onset neonatal sepsis: a multicenter case control study. Pediat rics 2000;105:21-6.
7. Gotoff SP. Neonatal sepsis and meningitis. In: Behrman RE, Kliegman RM, Alvin AM, editors. Textbook of pediatrics. 15th ed. Philadelphia: WB Saunders Co; 1996. p. 528-37.
8. Roberton NRC, Bacterial infection in the newborn. In: A manual of neonatal intensive care. 3rd ed. London: Arnold; 1993. p. 196-204.
9. Yu VYH. Monintja HE. Infeksi sistemik pada neonacus, In: Beberapa masalah perawatan intensif neonatus. Jakarta: Balai Penerbit FKUI; 1997. p. 217-30.
10_ Osh FA, Naiman JL. Hematologic problems in the newborn, In: Cloherty JP, Stark AN, editors. Manual of neonatal care. 3rd ed. Boston: Little Brown and Co; 1992. p. 727-8.
11. Ehl S, Getdng B, Bartmann P, Hogel J, Pohlandt F. C-reactive protein is a useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection. Pediatrics 1997;99:216-21.
12. Klein JO, Marcy SM, Bacterial sepsis and meningitis. In: Klein JO, Remington JS, editors, Infectious diseases of the fetus and newborn infant. 3rd ed. Philadelphia: WB Saunders Co; 1990. p. 627-35.
13. Anwer SK, Mustafa S. Rapid identification of neona tal sepsis. J Pakistan Med Ass 2000;50:94-8.
14. Zipursky A, Palku J, Milnner R, Akenzua GI. The hematology of bacterial infections in prematute infants. Pediatrics 1976;57:839-53.
15. Sackett DL, Strauss SE, Richarson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000. p. 35-54.