Prediction models for neonatal health care-associated sepsis: a meta-analysis.
Pediatrics
; 135(4): e1002-14, 2015 Apr.
Article
em En
| MEDLINE
| ID: mdl-25755236
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.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Unidades de Terapia Intensiva Neonatal
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Infecção Hospitalar
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Modelos Estatísticos
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Bacteriemia
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Sepse
Tipo de estudo:
Diagnostic_studies
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Guideline
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Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Humans
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Newborn
Idioma:
En
Revista:
Pediatrics
Ano de publicação:
2015
Tipo de documento:
Article