Diagnostic accuracy of the 2004 Indonesian Pediatric Society medical standard of care for neonatal sepsis
Keywords:
diagnostic test, 2004 IPS medical standard of care, neonatal sepsis
Abstract
Background Neonatal sepsis is a leading cause of neonatal morbidityand mortality. There are no pathognomonic signs or symptoms
to diagnose neonatal sepsis. Blood culture is the standard tool for
sepsis diagnosis, but it is not available in most district hospitals. In
2004, the Indonesian Pediatric Society (IPS) developed a medical
standard of care to diagnose neonatal sepsis, but its accuracy has
not been adequately verified.
Objective To evaluate the diagnostic accuracy of the IPS medical
standard of care 2004 to diagnose neonatal sepsis.
Methods We conducted diagnostic testing at the Perinatal
Ward, Dr. Sardjito Hospital, Yogyakarta, from June to November
2010. Inclusion criteria were neonates with signs and symptoms
of infection. We excluded neonates with congenital anomalies,
blood disorders, or whose mothers received peripartum antibiotic
treatment. All neonates were assessed by the 2004 IPS medical
standard of care for neonatal sepsis and by blood culture
examinations.
Results A total of 193 neonates with signs and symptoms of
infection were evaluated. The IPS medical standard had a
sensitivity of 88% (95% CI 81 to 94), specificity of 17% (95%
CI 2 to 25), positive predictive value of 53% (95% CI 45 to 60),
negative predictive value of 57% (95% CI 39 to 75), positive
likelihood ratio of 1.06 (95% CI 0.94 to 1.19), and negative
likelihood ratio of0.71 (95% CI 0.36 to 1.42).
Conclusion The 2004 IPS medical standard of care showed
adequate sensitivity for diagnosing neonatal sepsis, but its low
specificity limits its use as a diagnostic tool. [Paediatr lndones.
2012;52:86-90].
References
l. Tripathi S, Malik GK. Neonatal sepsis: past, present and future;
a review article. Internet J Med Update. 2010;5:45-54.
2. Yu VYH, Monintja HE. Beberapa masalah perawatan intensif
neonatus. Jakarta: Balai Penerbit Fakultas Kedokteran
Universitas Indonesia; 1997. p. 217-30.
3. Bentlin MR, Rugolo LMSS. Late-onset sepsis: epidemiology,
evaluation, and outcome. Neoreviews. 2010; 11:426-35.
4. Crews on PE. Fundamentals of clinical research for radiologists,
reader agreement studies. AJR. 2005;184:1391- 7.
5. Viera AJ, Garrett JM. Understanding interobserver
agreement: the Kappa statistic. Fam Med. 2005;37:360-3.
6. Anonym. Diagnostic tests. CRD's guidance for undertaking
reviews in health care. 2009 [cited 2010 December 10].
Available from: hup:/A111.vw.york.ac.uk/inst/crd/sysrev
7. Vergnano S, Sharland M, Kazembe C, Mwansambo P, Heath
T. Neonatal sepsis: an international perspective. Arch Dis
Child Fetal Neonatal. 2005;90:220--4.
8. Franz AR, Steinbach G, Kron M, Pohlandt F. Reduction
of unnecessary antibiotic therapy in newborn infants using
interleukin-8 and C-reactive protein as markers of bacterial
infections. Pediatrics. l 999;104:447-53.
9. Ho LY. Sepsis in young infants-rational approach to early
diagnosis and treatment. Singapore Med]. 1992;33:119-22.
10. Murti B. Prinsip clan metode riset epidemiologi. Jogjakarta:
Gadjah Mada University Press; 2003. p. 180-9 .
11. Pusponegoro HD, Wirya IGNW, Pudjiadi AH, Bisanto J,
Zulkanain S. Uji diagnostik. In: Sastroasmoro S, Ismael S,
editors. Dasar-dasar metodologi penelitian klinis, 2nd ed.
Jakarta: Sagung Seto; 2002. p. 172-80.
12. Deeks JJ. Systematic reviews of evaluations of diagnostic and
screening tests. BMJ. 2001;323: 157- 62.
13. Fischer JE. Physicians' ability to diagnose sepsis in
newborns and critically ill children. Pediatr Crit Care Med.
2005;6:120-5.
14. Gerdes JS, Polin R. Early diagnosis and treatment ofneonatal
sepsis. Indian J Pediatr. 1998;65:63-78.
15. Monintja HE. Experiences with neonatal septicemia. Majalah
Farmakologi clan Terapi. 1988;5:71-8.
16. Ranuh ION, Sarwono E, Hardjadinata D. Study on the
usefulness of clinical manifestations in the diagnosis ofneonatal
sepsis. Kobe: Proceedings of the ICMR seminar. 1983.
1 7. Mulyani A, Setyowireni D, Surj ono A. The diagnostic accuracy
of clinical and blood examination for sepsis in potentially
infected neonates. Berkala Ilmu Kedokteran. 2002;34: 149-54.
18. Desai KJ, Malek SS. Neonatal septicemia: bacterial
isolates & their antibiotics susceptibility patterns. NJIRM.
2010;1:12-5.
19. Vergnano S, Menson E, Kennea N, Embleton N, Russel BA,
Watts T, et al. Neonatal infections in England: the neoIN
surveillance network. Arch Dis Child Fetal Neonatal.
2011;96:9-14.
20. Kumar Y, Qunibi M, Neal TJ, Yoxall CW. Time to positivity
of neonatal blood cultures. Arch Dis Child Fetal Neonatal.
2001;85 :182-6.
a review article. Internet J Med Update. 2010;5:45-54.
2. Yu VYH, Monintja HE. Beberapa masalah perawatan intensif
neonatus. Jakarta: Balai Penerbit Fakultas Kedokteran
Universitas Indonesia; 1997. p. 217-30.
3. Bentlin MR, Rugolo LMSS. Late-onset sepsis: epidemiology,
evaluation, and outcome. Neoreviews. 2010; 11:426-35.
4. Crews on PE. Fundamentals of clinical research for radiologists,
reader agreement studies. AJR. 2005;184:1391- 7.
5. Viera AJ, Garrett JM. Understanding interobserver
agreement: the Kappa statistic. Fam Med. 2005;37:360-3.
6. Anonym. Diagnostic tests. CRD's guidance for undertaking
reviews in health care. 2009 [cited 2010 December 10].
Available from: hup:/A111.vw.york.ac.uk/inst/crd/sysrev
7. Vergnano S, Sharland M, Kazembe C, Mwansambo P, Heath
T. Neonatal sepsis: an international perspective. Arch Dis
Child Fetal Neonatal. 2005;90:220--4.
8. Franz AR, Steinbach G, Kron M, Pohlandt F. Reduction
of unnecessary antibiotic therapy in newborn infants using
interleukin-8 and C-reactive protein as markers of bacterial
infections. Pediatrics. l 999;104:447-53.
9. Ho LY. Sepsis in young infants-rational approach to early
diagnosis and treatment. Singapore Med]. 1992;33:119-22.
10. Murti B. Prinsip clan metode riset epidemiologi. Jogjakarta:
Gadjah Mada University Press; 2003. p. 180-9 .
11. Pusponegoro HD, Wirya IGNW, Pudjiadi AH, Bisanto J,
Zulkanain S. Uji diagnostik. In: Sastroasmoro S, Ismael S,
editors. Dasar-dasar metodologi penelitian klinis, 2nd ed.
Jakarta: Sagung Seto; 2002. p. 172-80.
12. Deeks JJ. Systematic reviews of evaluations of diagnostic and
screening tests. BMJ. 2001;323: 157- 62.
13. Fischer JE. Physicians' ability to diagnose sepsis in
newborns and critically ill children. Pediatr Crit Care Med.
2005;6:120-5.
14. Gerdes JS, Polin R. Early diagnosis and treatment ofneonatal
sepsis. Indian J Pediatr. 1998;65:63-78.
15. Monintja HE. Experiences with neonatal septicemia. Majalah
Farmakologi clan Terapi. 1988;5:71-8.
16. Ranuh ION, Sarwono E, Hardjadinata D. Study on the
usefulness of clinical manifestations in the diagnosis ofneonatal
sepsis. Kobe: Proceedings of the ICMR seminar. 1983.
1 7. Mulyani A, Setyowireni D, Surj ono A. The diagnostic accuracy
of clinical and blood examination for sepsis in potentially
infected neonates. Berkala Ilmu Kedokteran. 2002;34: 149-54.
18. Desai KJ, Malek SS. Neonatal septicemia: bacterial
isolates & their antibiotics susceptibility patterns. NJIRM.
2010;1:12-5.
19. Vergnano S, Menson E, Kennea N, Embleton N, Russel BA,
Watts T, et al. Neonatal infections in England: the neoIN
surveillance network. Arch Dis Child Fetal Neonatal.
2011;96:9-14.
20. Kumar Y, Qunibi M, Neal TJ, Yoxall CW. Time to positivity
of neonatal blood cultures. Arch Dis Child Fetal Neonatal.
2001;85 :182-6.
Published
2012-04-30
How to Cite
1.
Fitriani O, Suryantoro P, Wandita S, Wibowo T, Haksari E, Julia M. Diagnostic accuracy of the 2004 Indonesian Pediatric Society medical standard of care for neonatal sepsis. PI [Internet]. 30Apr.2012 [cited 25Apr.2024];52(2):86-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/324
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Received 2016-08-22
Accepted 2016-08-22
Published 2012-04-30
Accepted 2016-08-22
Published 2012-04-30
