LA CONSULTA SEMANAL

AGOSTO 2000

CONSULTA

Indian J Pediatr 2000 May;67(5):337-8
Value of superficial cultures in diagnosing neonatal sepsis.
Shenoy S, Antony G, Shenoy UV
Department of Microbiology, University Medical Centre, Kasturba Medical College, Mangalore, Karnataka.
This study was conducted to determine the value of superficial cultures in the diagnosis of neonatal sepsis in our hospital. Sixty three babies, younger than 2 weeks who were admitted with suspected sepsis were investigated. A total of 369 cultures were obtained from these babies--252 (68.29%) superficial and 171 (31.70%) deep cultures. External ear canal swab, umbilical cord swab and throat  swab culture accounted for the superficial cultures. Blood culture, cerebrospinal fluid culture and i.v. catheter culture accounted for deep cultures. Of the 369 cultures, 225 (60.97%) were positive for pathogens, which included Staphylococcus aureus, Klebsiella sp, Escherichia coli, Group B streptococcus and Enterococcus fecalis. The yield of pathogenic organisms was higher for superficial cultures (53.84%). All superficial cultures obtained during the study on each patient were simultaneously compared with the deep cultures by antimicrobial sensitivity method. The overall comparison showed that the practice of superficial cultures could be useful to predict the pathogenic organisms causing invasive disease.

JPMA J Pak Med Assoc 2000 Mar;50(3):94-8
Rapid identification of neonatal sepsis.
Anwer SK, Mustafa S
Department of Paediatrics, Abbasi Shaheed Hospital, Karachi.
OBJECTIVE: To achieve rapid identification of neonatal sepsis. SETTING: Neonatal Intensive care unit (NICU) of a teaching hospital. METHOD: We evaluated fifty neonates who were admitted with clinical features suggesting sepsis or who had principal risk factors, e.g. Prematurity (< 36 weeks), Low birth weight (< 2.5 kg), H/o maternal pyrexia or prolonged rupture of membranes, birth asphyxia, unbooked cases or instrumentation. Five tests, i.e., Total Leukocyte Count (T.L.C.), Absolute Neutrophil Count, Immature/Total Neutrophil ratio (I.T. ratio), Platelet count and C-Reactive protein were used for rapid diagnosis of neonatal sepsis. RESULTS: C-reactive protein (C.R.P.) and absolute Neutrophil count had a sensitivity of over 60% with a specificity of 50%. White blood cell count had a specificity of 93% but a sensitivity of 14%. CONCLUSION: None of the tests used alone were reliable, but when in combination these five tests may help to diagnose sepsis within a few hours. Also, if the tests show a high negative predictive value, the neonate can be discharged early from the hospital, stopping the antibiotics, thereby reducing the cost of treatment and anxiety of the family.

JPMA J Pak Med Assoc 2000 Mar;50(3):91-4
Neonatal sepsis: an etiological study.
Anwer SK, Mustafa S, Pariyani S, Ashraf S, Taufiq KM
Department of Paediatric, Abbasi Shaheed Hospital, Karachi.
OBJECTIVE: A periodic review of neonatal sepsis to asses any change in the infecting organism. METHOD: A prospective study was conducted at HMC and ASH, Karachi. The babies suspected to have or developed sepsis any time during hospitalization were investigated to establish the diagnosis and isolate the causative organism. Blood culture was taken at the time of admission or when sepsis was suspected. RESULTS: Out of 109 episodes of blood culture proven sepsis 68 presented as early onset (within 48 hours of birth) and 41 as late onset sepsis (after 48 hours of birth). In early onset group Gram -ve and Gram +ve organisms were almost equal, i.e. 33 and 35 respectively. Among the gram -ve organism most of the cases were due to Klebsiella sp, and Enterococcus was the commonest Gram +ve organism. In late onset group majority of infections were due to gram +ve organisms, i.e. 30 out of 41. Staph. aureus and Staph. epidermidis were commonest. The organisms were least sensitive to Ampicillin (< 20%) and highly sensitive to Amikacin (90% to 100%), Cefotaxime was also seen as a good choice of antibiotic with sensitivity of (84%-89%). CONCLUSION: Gram +ve organisms were the main cause of neonatal sepsis. Klebsiella sp. is still the commonest organism causing early onset sepsis. The data must be periodically reviewed and antibiotic policy revised accordingly.

Indian J Pediatr 1998 Jan-Feb;65(1):63-78
Early diagnosis and treatment of neonatal sepsis.
Gerdes JS, Polin R
Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA.
Perinatally acquired bacterial neonatal sepsis is a low incidence, high risk disease with a relatively benign treatment. Accurate diagnosis is difficult because there is no definitive diagnostic test; even blood cultures have an unacceptably low sensitivity. Therefore, the clinician must accept that a number of neonates who do not have the disease will have treatment initiated for sepsis. In order to treat rapidly all infants with sepsis and to minimize therapy for those without infection, historical, clinical, and laboratory data can be used together in a management approach to achieve optimal results. A systemized approach using history, examination, sepsis screen laboratory tests, and cultures is presented to guide clinical management.
Publication Types:
  Review
  Review, tutorial

Pediatrics 2000 Mar;105(3 Pt 1):523-7
Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system.
Garcia-Prats JA, Cooper TR, Schneider VF, Stager CE, Hansen TN
Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA. josephg@bcm.tmc.edu
BACKGROUND: Neonatal sepsis is a low incidence, high-risk disease with many sepsis work-ups performed to detect a single case. Seventy-two hours of antibiotic therapy have been traditionally recommended pending negative culture results. Improved culture media and new technology integrated into blood culture systems could shorten incubation time required to detect positive culture results. This would then change the length of antibiotic therapy in the management of the newborn infant with suspected sepsis. In addition, previous data supporting the 72-hour recommendation were retrospectively acquired, utilized nonautomated systems, and reported in an era with a different population of microorganisms cultured in special care nurseries. OBJECTIVE: Evaluate the time of incubation to detect positive blood cultures from newborn infants with suspected sepsis using a computer-assisted, automated blood culture system, ESP (Trek Diagnostic Systems, Inc, Westlake, OH). DESIGN: Prospective, observational study. PATIENTS AND SETTING: All positive blood culture results that were obtained from term and preterm newborn infants born from November 1993 through June 1997 at a publicly funded hospital with over 6000 live births per year. METHODS: As positive blood culture results were identified, data were prospectively obtained from the patient's medical record. The computer algorithm in the automated blood culture system determined the time to positivity. Time to positivity was determined for blood cultures obtained before the initiation antimicrobial therapy and compared with those cultures obtained after beginning therapy. Time to positivity was also evaluated for clinically important Gram-positive and Gram-negative bacteria and yeast. RESULTS: Four hundred fifty-five positive blood culture results were obtained from 222 patients. Gram-positive organisms accounted for 80% (366/455) of the positive culture results, Gram-negative organisms accounted for 11% (48/455), and yeast for 9% (41/455). Virtually all cultures growing clinically significant Gram-positive and Gram-negative organisms were positive by 24 to 36 hours of incubation. Cultures growing Staphylococcus epidermidis were virtually all positive after 36 to 48 hours of incubation. Of cultures growing yeast, 88% (36/41) were positive by 48 hours of incubation. There was no difference in time to positivity in pretherapy or posttherapy obtained positive blood cultures. Prenatally administered antibiotics did not affect time to positivity in positive cultures drawn on the first day of life. In a selected group of microorganisms that are the frequent cause of bacteremia in term infants, 97% and 99% of cultures were positive by 24 to 36 hours of incubation when only pretherapy cultures are evaluated. CONCLUSIONS: The ESP blood culture system identified 77%, 89% and 94% of all microorganisms at 24, 36, and 48 hours of incubation in aerobic cultures obtained from both term and preterm infants. Introduction of antimicrobial therapy did not affect time to positivity. Reducing duration of antibiotic therapy to 24 to 36 hours should be considered in term, asymptomatic newborn infants undergoing evaluation for suspected sepsis for maternal indications. Confirmation of similar rapidity of detection using other blood culture systems should be undertaken.

Eur J Obstet Gynecol Reprod Biol 1999 Aug;85(2):151-8
Risk factors associated with early-onset sepsis in premature infants.
Martius JA, Roos T, Gora B, Oehler MK, Schrod L, Papadopoulos T, Gross U
Department of Obstetrics and Gynecology, University of Wuerzburg, Germany.
OBJECTIVE: To define perinatal factors associated with early-onset neonatal sepsis. STUDY DESIGN: Maternal and neonatal variables were analysed retrospectively in 343 infants born before 35 weeks using univariate and multivariate statistical analysis. RESULTS: Logistic regression analysis identified risk factors for probable neonatal sepsis: gestational age at delivery (odds ratio 0.9, 95% confidence interval (CI) 0.91-0.96), premature rupture of the membranes (odds ratio 2.9, 95% CI 1.004-8.56), Apgar score after 1 min (odds ratio 0.7, 95% CI 0.53-0.96), and histological chorioamnionitis and/or funisitis (odds ratio 4.1, 95% CI 1.36-12.12). There was a strong association between probable sepsis and intracranial haemorrhage of the infant (odds ratio 4.3, 95% CI 1.07-17.40). Funisitis had a high specificity (91%) and positive predictive value (82%) for the detection of neonatal sepsis < or =32 weeks. CONCLUSIONS: Independent obstetrical risk factors for early-onset neonatal sepsis in premature infants may help to identify newborns who benefit from maternal antibiotic prophylaxis before birth. The histological examination of the umbilical cord can be used as an additional diagnostic test to detect newborns at risk of infection.

Am J Obstet Gynecol 1999 Nov;181(5 Pt 1):1197-202
Incidence of intrapartum maternal risk factors for identifying neonates at risk
for early-onset group B streptococcal sepsis: A prospective study.
Towers CV, Rumney PJ, Minkiewicz SF, Asrat T
University of California, Irvine, USA.
OBJECTIVE: In mid-1996 and early 1997, the Centers for Disease Control and Prevention, The American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics all published guidelines outlining 2 potential strategies for the purpose of preventing neonatal sepsis caused by group B Streptococcus. One of these approaches involves treating pregnant women intrapartum with antibiotics if any of the following risk factors develop: delivery at <37 weeks' gestation, membrane rupture for >/=18 hours' duration, or temperature during labor of >/=38 degrees C. However, to date there have been no population-based studies that have ascertained the percentage of pregnant women eligible to receive intrapartum antibiotic chemoprophylaxis if these risk factors were used. Our objective was to perform a large patient-based study at >1 institution evaluating all deliveries for the presence of maternal risk factors by using the definitions of the current guidelines. STUDY DESIGN: A prospective cohort study was initiated in 1995 at 3 private community hospitals and 1 private referral center. The study population was composed of 5410 consecutively delivered patients from the 4 different hospitals. Every pregnancy was analyzed for gestational age at delivery, duration of membrane rupture, temperature during labor, and use of intrapartum antibiotic chemoprophylaxis. RESULTS: Of the 5410 patients, a total of 455 (8. 4%) were delivered of their neonates before 37 weeks' gestation, 421 (7.8%) had rupture of membranes for at least 18 hours' duration, and 378 (7.0%) had an intrapartum temperature of >/=38 degrees C. Overall, 1071 pregnant women (19.8% of the population studied) had >/=1 of the defined risk factors. CONCLUSIONS: These data suggest that, if the current risk factor strategy is used, 19.8% of the delivering population would potentially be candidates for intrapartum antibiotic chemoprophylaxis.

Acta Paediatr 1999 Aug;88(8):880-4
Contribution of interleukin-6 in distinguishing between mild respiratory disease and neonatal sepsis in the newborn infant.
Kallman J, Ekholm L, Eriksson M, Malmstrom B, Schollin J
Department of Infectious Diseases, Vasteras Medical Centre Hospital, Sweden.
The purpose of this study was to investigate if early samples of interleukin-6 (IL-6) could distinguish early bacterial sepsis from respiratory diseases in the newborn. IL-6 and C-reactive protein (CRP) were measured at onset of symptoms in newborns evaluated for sepsis during the first week of life. Five groups of children were investigated: proven sepsis, clinical sepsis, respiratory distress syndrome (RDS), transient tachypnoea of the newborn (TTN) and controls. IL-6 was also analysed at the time when CRP was at its maximum level. The results showed that initial IL-6 distinguished proven and clinical sepsis from TTN, but not from RDS. Initial CRP was of no value for diagnosis. Our conclusion is that early IL-6 makes it possible to avoid antibiotics in children with TTN and contributes to the diagnosis of sepsis faster than CRP.

Acta Paediatr 1999 Jun;88(6):647-50
Evaluation of interleukin-6, tumour necrosis factor-alpha and interleukin-1beta for early diagnosis of neonatal sepsis.
Silveira RC, Procianoy RS
Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
The objective of this study was to assess the contribution of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) to an early diagnosis of early-onset neonatal sepsis. A cohort of 117 newborn infants delivered during a 1-y period had IL-6, TNF-alpha and IL-1beta, blood and cerebrospinal fluid (CSF) cultures, leucocyte and platelet count collected on the initial evaluation of possible early-onset sepsis. They were divided into four groups: I, positive blood and/or CSF cultures; II, probably infected with clinical sepsis but negative cultures; III, same as group II but mother received antibiotic antepartum; and IV, newborn infants that did not receive any antibiotic therapy. There were no differences among the four groups with respect to mean gestational ages and birthweights, median Apgar scores, type of delivery, or number of newborn infants with leucocyte count <5000 mm(-3) or >25000 mm(-3), platelet count <100000 mm(-3), immature/total neutrophil ratio >0.2, absolute neutrophil count <1000mm(-3) and median IL-1beta levels. Median IL-6 and TNF-alpha levels were significantly higher in groups with patients with a diagnosis of clinical sepsis than in controls. The optimal cut-off point was 32 pg ml(-1) for IL-6 and 12 pg ml(-1) for TNF-alpha. The combination of both provided a sensitivity of 98.5%. In conclusion, the combination of IL-6 and TNF-alpha is a highly sensitive marker of sepsis in the immediate postnatal period.
Comments:
  Comment in: Acta Paediatr 1999 Jun;88(6):585-6

Lancet 1999 May 22;353(9166):1798-9 [Texto completo]
Interleukin-6 concentrations in neonatal sepsis.
Mehr S, Doyle L
Publication Types:
  Comment
  Letter
Comments:
  Comment on: Lancet 1999 Jan 16;353(9148):239-40

J Matern Fetal Med 1999 May-Jun;8(3):88-94
Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis.
Smulian JC, Vintzileos AM, Lai YL, Santiago J, Shen-Schwarz S, Campbell WA
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick 08903-0591, USA. smuliajc@umdnj.edu
OBJECTIVE: The purpose of this study was to determine whether elevated levels of umbilical vein IL-6 would be a better marker for early neonatal sepsis than the clinical signs of maternal chorioamnionitis. METHODS: Patients delivering preterm because of spontaneous preterm labor or premature rupture of the membranes were evaluated for clinical signs of chorioamnionitis, which was defined as a temperature of > or =100.4 degrees F along with > or =2 of the following: significant maternal tachycardia (> or = 120 bpm), fetal tachycardia (> or =160 bpm), purulent discharge, uterine tenderness, and leukocytosis (WBC > or =18,000 cells/mm3). Umbilical vein blood was assayed for interleukin-6. An elevated interleukin-6 level was determined to be 25 pg/mL. Infants were evaluated for evidence of early neonatal sepsis. The abilities of clinical chorioamnionitis and interleukin-6 levels > or =25 pg/mL to predict early neonatal sepsis were compared. RESULTS: There were 28 patients delivering 14 (50%) neonates with evidence for early neonatal sepsis. The incidence of suspected neonatal sepsis in women with and without clinical chorioamnionitis was 6/10 (60%) vs. 8/18 (44.4%), P = 0.43. Using receiver operator characteristic curves, the best cutoff for interleukin-6 was found to be 25 pg/mL. The compared sensitivity, specificity, and positive and negative predictive values of clinical chorioamnionitis vs. interleukin-6 levels > or =25 pg/mL for predicting early neonatal sepsis were 42.9% vs. 92.9%, 71.4% vs. 92.9%, 60% vs. 92.9%, and 55.6% vs. 92.9%, respectively. CONCLUSIONS: Elevated umbilical vein levels of interleukin-6 predict those preterm infants with early sepsis better than the presence of clinical chorioamnionitis.

Rev Invest Clin 1998 Nov-Dec;50(6):463-70
[Five year experience with neonatal sepsis in a pediatric center].
Zamora-Castorena S, Murguia-de-Sierra MT
Hospital Infantil de Mexico Federico Gomez, Mexico, D.F.
OBJECTIVE: To describe the etiologic agents, clinical findings and hematologic changes associated to sepsis in patients admitted to the Neonatal Intensive Care Unit at the Hospital Infantil de Mexico Federico Gomez and to determine the frequency of normal CBC (Complete Blood Cell Count) at diagnosis of sepsis. METHODS: A chart review of septic patients hospitalized from January 1992 to December 1996 was done. RESULTS: 103 septic patients with 147 episodes of bacteremia were detected among 945 newborn admissions. The most common isolates in blood cultures were grampositive cocci (55%). Clinical findings associated to sepsis were non-specific. Premature infants presented apnea and jaundice more frequently than term infants (p < 0.05). At diagnosis of sepsis, 19% of premature infants had a normal CBC compared to 8% of term infants. Leukopenia was a poor prognosis-related finding, i.e. seven out of 35 patients who died were leukopenic vs 1 of 68 survivors (p < 0.05). Overall, mortality was 34%, but sepsis-related mortality was 13%. CONCLUSIONS: The incidence of sepsis in our population was high with grampositive cocci as the most common blood isolates. Clinical features associated to sepsis were non-specific. A significant proportion of septic preterm infants had normal CBC at diagnosis and leukopenia was a poor prognosis sign. Mortality associated to sepsis was high.

Pediatrics 1999 Jan;103(1 Suppl E):360-73
The neonatal "sepsis work-up": personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization.
Escobar GJ
Kaiser Permanente Medical Care Program Division of Research, Perinatal Research Unit, Oakland, California 94611, USA.
"Rule out sepsis" may be the most common discharge diagnosis among infants admitted to the neonatal intensive care unit. Although the frequency of sepsis, meningitis, and other confirmed bacterial infections has remained constant (between 1 and 5/1000 live births) for many years, the number of infants evaluated and treated is much higher. Each year in the United States, as many as 600 000 infants experience at least one evaluation for suspected bacterial infection during the birth hospitalization. The number treated is estimated at 130 000 to 400 000 per year. Despite massive overtreatment, delayed diagnosis still occurs. The Kaiser Permanente Medical Care Program (KPMCP) considers developing and implementing an evidence-based approach to "rule out sepsis," a research and operational priority. To achieve these goals, it is essential to consider two key aspects of the problem. First, it is important to adopt a phenomenologic approach that takes clinicians' personal experience into account. This must include reflection on those aspects of experience often considered "irrational" or "subjective." Second, incorporation of a phenomenologic approach needs to be tempered with sound epidemiologic methods. If one considers these two aspects-physician experience and sound epidemiology-it is clear that much of the existing literature on "rule out sepsis" is of limited utility. Consequently, the KPMCP has conducted its own studies. These are aimed at characterizing the "sepsis work-up," developing electronic datasets that would permit clinicians to simulate various strategies, and developing techniques for ongoing electronic monitoring. This article summarizes the approach taken by the KPMCP Division of Research. It describes the results of a pilot study as well as the development and use of a dedicated neonatology outcomes database, the Kaiser Permanente Neonatal Minimum Data Set (NMDS). The NMDS database includes the Score for Neonatal Acute Physiology and permits ongoing monitoring of sepsis "work-ups" as well as confirmed cases of neonatal infection. The article also describes how the experience from the pilot as well as the NMDS was incorporated in the design of a much larger study on "rule out sepsis." Finally, the article describes some important theoretic issues affecting decision rule development and the use of computer simulations in neonatology. These issues are 1) how one handles possible overanalysis of a dataset; 2) how one handles data points that are unstable (eg, the absolute neutrophil count, which can vary considerably depending on age and sampling conditions); and 3) the limitations of decision rules based on computer simulations.
 

J Perinatol 1998 Mar-Apr;18(2):135-7
Placental blood sampling: an aid to the diagnosis of neonatal sepsis.
Herson VC, Block C, McLaughlin JC, Tetreault J, Eisenfeld LI, Krause PJ
Department of Pediatrics, Connecticut Children's Medical Center, Hartford 06102, USA.
OBJECTIVE: To determine the usefulness of placental blood cultures in establishment of the diagnosis of early onset sepsis. STUDY DESIGN: Babies born to mothers with suspected intraamniotic fluid infection had blood cultures obtained from a branch of the umbilical vein on the fetal surface of the placenta immediately after delivery. The babies at highest risk (n = 35) had subsequent neonatal blood cultured from a peripheral vein (group 1), whereas 26 newborns at a lower risk did not (group 2). A group of 20 term babies born after uncomplicated labor and vaginal delivery or by elective cesarean delivery served as control subjects. RESULTS: Placental blood cultures were more often positive for pathogens in group 1 (7 of 35; 20%; 0.09 to 0.36) than in group 2 (0 of 26; 0 to 0.11) or control subjects (0 of 20; 0 to 0.14; p < 0.02). Within group 1, placental blood cultures were more often positive (7 of 35; 20%; 0.09 to 0.36) than subsequent neonatal blood cultures (1 of 35; 3%; 0 to 0.15; p < 0.05). Contaminants were cultured in 3 of 81 (4%; 01 to 0.11) placental samples (all from group 1) compared with 1 of 35 (3%; 0 to 0.11) neonatal samples (difference not significant). CONCLUSIONS: A carefully obtained culture of placental blood may be a useful addition or substitute for neonatal blood culturing in newborns at risk for early-onset sepsis by virtue of maternal risk factors.

Arch Dis Child Fetal Neonatal Ed 1997 Nov;77(3):F221-7
Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants.
Ng PC, Cheng SH, Chui KM, Fok TF, Wong MY, Wong W, Wong RP, Cheung KL
Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, New Territories Hong Kong, People's Republic of China.
AIMS: To evaluate the commonly used markers--namely IL-6, TNF alpha, IL-1 beta, C-reactive protein and E-selection for identification of late onset neonatal sepsis; to define the optimal cutoff value for each marker in preterm neonates; to assess whether these markers could assist in early discontinuation of antibiotics in non-infected cases; and to delineate the profile of these markers during systemic infection and in relation to successful treatment. METHODS: Very low birthweight infants in whom clinical sepsis was suspected when they were > 72 hours of age were eligible for study. A full sepsis screen was performed in each episode. Cytokines, C-reactive protein, and E-selectin were serially
measured on days 0 (at the time  of sepsis evaluation), 1, 2, 4 and 7. The optimal cutoff value for each marker was calculated after minimising the number of misclassified episodes over all possible cutoff values for days 0 and 1. The sensitivity, specificity, positive and negative predictive values for each test and combination of tests for predicting systemic infection were also determined. RESULTS: One hundred and one episodes of suspected clinical sepsis were investigated in 68 infants. Forty five episodes were proved to be infections. The optimal cutoff values were IL-6 31 pg/ml, TNF alpha 17 pg/ml, IL-1 beta 1 pg/ml, C reactive protein 12 mg/l and E-selectin 174 ng/ml. IL-6 had the highest sensitivity (89%) and negative predictive value (91%) for detecting late onset infection on day 0. However, between 24 and 48 hours of onset, C-reactive protein was the best single marker, with an overall sensitivity and specificity of 84% and 96%, respectively. The use of serial and multiple markers in the first 48 hours further enhanced the sensitivity and specificity of these tests. Performing IL-6 and C-reactive protein on day 0, together with either TNF alpha on day 1 or C-reactive protein on day 2, showed the best overall sensitivity (98%) and specificity (91%) for the diagnosis of late onset infection. CONCLUSIONS: Optimal cutoff values for these markers in detecting late onset systemic infection in very low birthweight infants have been defined. Withholding antibiotic treatment at the onset of infection could be fatal and is not recommended, but the concomitant use of IL-6 and C-reactive protein or TNF alpha should allow antimicrobial treatment to be discontinued at 48 hours without waiting for microbiological results, provided that the infants are in good clinical condition.
Publication Types:
  Clinical trial
  Controlled clinical trial

Acta Paediatr 1997 Oct;86(10):1097-9
Rapid detection of neonatal sepsis using polymerase chain reaction.
Laforgia N, Coppola B, Carbone R, Grassi A, Mautone A, Iolascon A
Dipartimento di Biomedicina dell'Eta Evolutiva, Universita degli Studi, Bari, Italy.
Clinical diagnosis of sepsis in newborn infants is not easy and there is no laboratory test with 100% specificity and sensitivity, with the exception of blood culture, the results of which are not available for at least 48-72 h. Polymerase chain reaction methodology has been used to diagnose different bacterial, viral and protozoal infections, and the possibility of amplifying the DNA region common to all bacteria could represent an optimal method for the diagnosis of sepsis. The authors have performed PCR in a group of 33 neonates at risk for early-onset sepsis, correlating molecular data with blood culture results. The presence of bacterial DNA in blood samples was evaluated, amplifying the DNA region encoding the 16S rRNA. There were no false negative results (four positive blood cultures and four positive PCR), with competitive costs and time. This method also allows the diagnosis of sepsis due to uncommon species and also, using a second PCR with specific primers, an aetiological diagnosis.

Acta Paediatr 1997 Sep;86(9):999-1002
The value of immunoglobulin and complement levels in the early diagnosis of neonatal sepsis.
Kalayci AG, Adam B, Yilmazer F, Uysal S, Gurses N
Department of Paediatrics, Ondokuz Mayis University, School of Medicine, Samsun, Turkey.
Serum IgG, IgG1, G2, G3, G4, IgM, C3c and C4 concentrations were measured in 24 term neonates with sepsis and 17 healthy normal neonates of similar age, sex and weight (control group). The serum IgG, IgG1, G2, G3, G4, IgM, C3c, and C4 levels were similar in the patients with sepsis and the control group (p > 0.05). In the neonates with sepsis, serum IgG, G1, G2, IgM and C4 levels were not significantly different between the 1st and 10th days, while there were significant differences for IgG3, G4 and C3c (p < 0.05). We conclude that the serum levels of IgG, IgG1, G2, G3, G4, IgM, C3c and C4 concentrations are of no value for the early diagnosis of neonatal sepsis.

Pediatrics 1996 Jun;97(6 Pt 1):930; discussion 930-1
Lumbar puncture in the evaluation for early neonatal sepsis.
Beeram M, Oltorf C, Cipriani C
Publication Types:
  Comment
  Letter
Comments:
  Comment on: Pediatrics 1995 Jun;95(6):803-6