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Prediction models for neonatal health care-associated sepsis: a meta-analysis

Evelien Verstraete (UGent) , Koen Blot (UGent) , Ludo Mahieu, Dirk Vogelaers (UGent) and Stijn Blot (UGent)
(2015) PEDIATRICS. 135(4). p.e1002-e1014
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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.
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

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Chicago
Verstraete, Evelien, Koen Blot, Ludo Mahieu, Dirk Vogelaers, and Stijn Blot. 2015. “Prediction Models for Neonatal Health Care-associated Sepsis: a Meta-analysis.” Pediatrics 135 (4): e1002–e1014.
APA
Verstraete, Evelien, Blot, K., Mahieu, L., Vogelaers, D., & Blot, S. (2015). Prediction models for neonatal health care-associated sepsis: a meta-analysis. PEDIATRICS, 135(4), e1002–e1014.
Vancouver
1.
Verstraete E, Blot K, Mahieu L, Vogelaers D, Blot S. Prediction models for neonatal health care-associated sepsis: a meta-analysis. PEDIATRICS. 2015;135(4):e1002–e1014.
MLA
Verstraete, Evelien, Koen Blot, Ludo Mahieu, et al. “Prediction Models for Neonatal Health Care-associated Sepsis: a Meta-analysis.” PEDIATRICS 135.4 (2015): e1002–e1014. Print.
@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 {\textrangle}= 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},
  keyword      = {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://dx.doi.org/10.1542/peds.2014-3226},
  volume       = {135},
  year         = {2015},
}

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