Diagnostic accuracy of septic markers for neonatal sepsis
Keywords:
neonatal sepsis, septic markers, blood culture
Abstract
Background Neonatal sepsis is a major cause of morbidity andmortality. A positive blood culture is the gold standard for
diagnosis of neonatal sepsis. The signs and symptoms suggesting
neonatal sepsis are non-specific. There is no rapid and reliable
laboratory test findings for confirmation of etiologic diagnosis.
Clinical signs, symptoms, and laboratory examinations are not
perceived as sensitive or specific for diagnosis of sepsis.
Objective The purpose of this study was to evaluate the accuracy
of the septic markers for diagnosis of neonatal sepsis.
Methods Blood culture was used as gold standard to compare
septic markers to diagnose neonatal sepsis. Sensitivity, specificity,
positive predictive value (PPV), negative predictive value (NPV),
positive and negative likelihood ratio (LR), and accuracy were
calculated.
Results We identified 130 cases suspected of neonatal sepsis during
September 2005 until March 2006. Four patients were excluded
because of major congenital anomalies. The mean age was 2.2 days
and 51.6% were boys. We found fifty six (44.4%) neonates have
positive blood culture. All of septic markers had sensitivity more
than 80%. Immature to Total Neutrophil ratio (Iff) ratio had the
highest sensitivity (96.4%) and C-Reactive Protein (CRP) had the
lowest sensitivity (80.4o/o). Combination among leukocyte count,
thrombocyte, and Iff ratio had the highest sensitivity (sensitivity
was 85. 7%, specificity was 97.1 o/o, positive predictive value was
95.9%, negative predictive value was 89.5%, accuracy was 94.4%,
and positive likelihood ratio was 30.0).
Conclusion Septic markers can be used in the diagnostic
evaluation of neonates with suspected sepsis.
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Kedokteran Universitas Udayana; 1997.
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27. Philip AG, Hewitt JR. Early diagnosis of neonatal sepsis.
Pediatrics 1980;65 (5): 1036-41.
28. Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of
neonatal sepsis using a hematologic scoring system. J Pediatr
1998; 112:761-6.
29. Andayani P. Nilai diagnostik gambaran darah tepi sepsis
neonatorum [thesis]. Denpasar: Lab/SMF Ilmu Kesehatan
Anak Fakultas Kedokteran Universitas Udayana; 2002.
30. Bizzaro MJ, Rackind C, Baltimore RS, Gallagher PG. Seventy-
five years of neonatal sepsis at Yale: 1928-2003. Pediatrics
2005; 116:595-602.
Fungal Infections. In: MacDonald MG, Seshia MMK,
Mullett MD, editors. Avery's Neonatology Pathophysiology
& Management of the Newborn. 6th ed. Philadelphia:
Lippincott Williams & Wilkins; 2005. p. 1235-73.
2. Naglie R. Infectious disease. In: Gomella TL, Cunningham
MD, Eyal FG, Zenk KE, editors. Neonatology: management,
procedures, on-call problems, disease, and drugs. yh ed. New
York: Lange Medical Books/McGraw-Hill; 2004. p. 434-68.
3. Bellig L. Neonatal sepsis. Available from: uri: http: //www.
emedicine.com/PED/topics2630.htm.
4. Brilli RJ, Golstein B. Pediatric sepsis definitions: Past, present,
and future. Pediatr Crit Care Med 2005;6 Suppl 2:S6-8.
5. Suarca IK, Kardana M, Iswari IS. Blood culture and
sensitivity test pattern of early versus late onset sepsis in
neonatal ward Sanglah Hospital Denpasar. Presented at
the 13th National Congress of Child Health Konika XIII,
Bandung, July 4-7, 2005.
6. Aminullah A. Diagnosis dan tata laksana sepsis pada bayi
baru lahir. In: Wahono SS, Lany L, Herminto W, Irawaty
A, editors. Naskah lengkap simposium nasional "Hot topic
in paediatrics" Pediatri Gawat Darurat, Kardiologi Anak,
dan Perinatologi. Kalimantan Timur: Ikatan Dokter Anak
Indonesia, 2006. p. 221-35.
7. Stoll BJ. Infections of the Neonatal Infant. In: Nelson WE,
Behrman RE, Kliegman RM, Jehnson HB, editors. Nelson
Texthbook of Pediatrics. 17th ed. Philadelphia: W.B. Saunders
Company; 2004. p. 623-40.
8. Polin RA, Parravicini E, Regan JA, Taeusch HW. Bacterial
sepsis and meningitis. In: Taeusch HW, Ballard RA, editors.
Avery's disease of the newborn. 8th ed. Philadelphia:
Lippincott Williams & Wilkins; 1998. p. 551-77.
9. Deorari AK. Laboratory diagnosis of neonatal sepsis.
Presented at the 14th National Congress of Child Health
Konika XIII, Bandung, July 4-7, 2005.
10. Mathur M, Shah H, Dixit K, Khambadkone S, Chakrapani
A, Irani S. Bacteriological profile of neonatal septicemia cases
(for the year 1990-91). J Posttgrad Med 1994;40: 18-20.
11. Indarso F, Harianto A, Etika R, Damanik SM, Hidayat B,
Ismoedijanto. Multidiscipline approaches in eradicating
septicaemia outbreaks. Presented at the 13th National Congress
of Child Health Konika XIII, Bandung, July 4-7,2005.
12. Blanchette V, Dror Y, Chan A. Hematology. In: MacDonald
MG, Seshia MMK, Mullett MD, editors. Avery's Neonatology
Pathophysiology & Management of the Newborn. 6th ed.
Philadelphia: Lippincott Williams & Wilkins; 2005. p.
1169-1234.
13. Rohsiswatmo R. Kontroversi diagnosis sepsis neonatorum.
In: Hegar B, Triono PP, Ifran EB, editors. Update in neonatal
infection. Pendidikan kedokteran berkelanjutan Ilmu Kese-
hatan Anak XLVIII. Jakarta: Departemen Ilmu Kesehatan
Anak FKUI-RSCM; 2005. p. 32-43.
14. Haque KN. Definitions of bloodstream infection in the
newborn. Pediatr Crit Care Med 2005;6 Suppl:S45-9.
15. Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico
L. Diagnosis of neonatal sepsis: A clinical and laboratory
challenge. Clinical Chemestry 2004;2:267 -79.
16. Bain BJ. The bayertechnicon series of automated haematology
instruments. In: Brugnara C, Von Kapff CT, editors.
Connecticut: Bayer Corporation; 1996. p. 7-16.
17. Kuhle S, Mitchell L, Massicotte P, Andrew M. Hematologic
disorders of the newborn. In: Taeusch HW, Ballard RA,
editors. Avery's disease of the newborn. 8th ed. Philadelphia:
Lippincott Williams & Wilkins; 1998. p. 1145-70.
18. Sepsis Neonatal. Standar Pelayanan Medik Divisi
Perinatologi FKUI!RSCM, 2004.
19. Goldstein B, Giroir B, Randolph A. Members of the
international concensus conference on neonatal sepsis.
Definitions for sepsis and organ disfunction in pediatrics.
Pediatr Crit Care Med 2005;6:2-8.
20. McLean AD. Congenital anomalies. In: MacDonald MG,
Seshia MMK, Mullett MD, editors. Avery's Neonatology
Pathophysiology & Management of the Newborn. 6th ed.
Philadelphia: Lippincott Williams & Wilkins; 2005. p. 892-
913.
21. Manroe BL, Weiberg AG, Rosenfeld CR. The neonatal blood
count in health and diseases. J Pediatr 1979;98:89-98.
22. Ng PC. Diagnostic markers of infection in neonates. Arch
Disch Child Fetal Neonatal Ed. 2004;89:229-35.
23. HengstJM. The role ofC-Reactive Protein in the evaluation
and management of infants with suspected sepsis. Adv
Neonatal Care 2003;3:3-13.
24. Nupponen I, Anderson S, Jarvenpaa AL, Kautiainen H,
Repo H. Neutrophil CD11b expression and circulating
interleukin-8 as diagnostic markers for early-onset neonatal
sepsis. Pediatrics 2001;108:12-7.
25. Prayoga AAN. Akurasi C-reaktif protein sebagai alat
diagnosis cepat sepsis/meningitis bakteri pada neonatus
[thesis]. Denpasar: Lab/SMF Ilmu Kesehatan Anak Fakultas
Kedokteran Universitas Udayana; 1997.
26. Siebert K, Dorey JCG, and Embury D. The value ofC-reactive
protein measurement in the diagnosis of neonatal infection.
J. Pediatr Child Health 1990;26:267-70.
27. Philip AG, Hewitt JR. Early diagnosis of neonatal sepsis.
Pediatrics 1980;65 (5): 1036-41.
28. Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of
neonatal sepsis using a hematologic scoring system. J Pediatr
1998; 112:761-6.
29. Andayani P. Nilai diagnostik gambaran darah tepi sepsis
neonatorum [thesis]. Denpasar: Lab/SMF Ilmu Kesehatan
Anak Fakultas Kedokteran Universitas Udayana; 2002.
30. Bizzaro MJ, Rackind C, Baltimore RS, Gallagher PG. Seventy-
five years of neonatal sepsis at Yale: 1928-2003. Pediatrics
2005; 116:595-602.
Published
2016-09-15
How to Cite
1.
AS T, Retayasa W, Kardana M, Lila I. Diagnostic accuracy of septic markers for neonatal sepsis. PI [Internet]. 15Sep.2016 [cited 22Nov.2024];48(5):299-05. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/610
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Received 2016-09-12
Accepted 2016-09-12
Published 2016-09-15
Accepted 2016-09-12
Published 2016-09-15
