@article{5908955,
  abstract     = {{BACKGROUND AND OBJECTIVES: Blood culture is the gold standard to diagnose bloodstream infection but is usually time-consuming. Prediction models aim to facilitate early preliminary diagnosis and treatment. We systematically reviewed prediction models for health care-associated bloodstream infection (HABSI) in neonates, identified superior models, and pooled clinical predictors. Data sources: LibHub, PubMed, and Web of Science. 
METHODS: The studies included designed prediction models for laboratory-confirmed HABSI or sepsis. The target population was a consecutive series of neonates with suspicion of sepsis hospitalized for >= 48 hours. Clinical predictors had to be recorded at time of or before culturing. Methodologic quality of the studies was assessed. Data extracted included population characteristics, total suspected and laboratory-confirmed episodes and definition, clinical parameter definitions and odds ratios, and diagnostic accuracy parameters. 
RESULTS: The systematic search revealed 9 articles with 12 prediction models representing 1295 suspected and 434 laboratory-confirmed sepsis episodes. Models exhibit moderate-good methodologic quality, large pretest probability range, and insufficient diagnostic accuracy. Random effects meta-analysis showed that lethargy, pallor/mottling, total parenteral nutrition, lipid infusion, and postnatal corticosteroids were predictive for HABSI. Post hoc analysis with low-gestational-age neonates demonstrated that apnea/bradycardia, lethargy, pallor/mottling, and poor peripheral perfusion were predictive for HABSI. Limitations include clinical and statistical heterogeneity. 
CONCLUSIONS: Prediction models should be considered as guidance rather than an absolute indicator because they all have limited diagnostic accuracy. Lethargy and pallor and/or mottling for all neonates as well as apnea and/or bradycardia and poor peripheral perfusion for very low birth weight neonates are the most powerful clinical signs. However, the clinical context of the neonate should always be considered.}},
  author       = {{Verstraete, Evelien and Blot, Koen and Mahieu, Ludo and Vogelaers, Dirk and Blot, Stijn}},
  issn         = {{0031-4005}},
  journal      = {{PEDIATRICS}},
  keywords     = {{BLOOD-STREAM INFECTIONS,HEART-RATE CHARACTERISTICS,LATE-ONSET SEPSIS,NEGATIVE STAPHYLOCOCCAL BACTEREMIA,HOSPITAL-ACQUIRED INFECTIONS,BIRTH-WEIGHT INFANTS,RISK-FACTORS,NOSOCOMIAL SEPSIS,CLINICAL SIGNS,PRETERM INFANTS}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{e1002--e1014}},
  title        = {{Prediction models for neonatal health care-associated sepsis: a meta-analysis}},
  url          = {{http://doi.org/10.1542/peds.2014-3226}},
  volume       = {{135}},
  year         = {{2015}},
}

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