title: Nosocomial sepsis risk score for preterm infants in low-resource settings.
abstract: Sepsis is a leading cause of mortality for neonates in developing countries; however, little research has focused on clinical predictors of nosocomial infection of preterm neonates in the low-resource setting. We sought to validate the only existing feasible score introduced by Singh et al. in 2003 and to create an improved score. In a secondary analysis of daily evaluations of 497 neonates <or=33 weeks gestational age admitted to a tertiary care NICU in Dhaka, Bangladesh, we tested the Singh score and then constructed and internally validated our own bedside predictive score. The Singh score had low sensitivity of 56.6% but good positive predictive value (PPV) of 78.1% in our sample. Our five-sign model requiring at least one clinical sign of infection (apnea, hepatomegaly, jaundice, lethargy and pallor) had an area under the receiver operating characteristic of 0.70, sensitivity of 77.1%, and PPV of 64.9%. Our clinical sepsis score is the first bedside clinical screen exclusively for hospitalized, very premature neonates in a low-resource setting, and warrants external validation.
authors.affiliation: Department of International Health, International Center for Advancing Neonatal Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Rosenberg
authors.forename: A S M Nawshad U
authors.initials: AS
authors.lastname: Ahmed
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: M A K Azad
authors.initials: MA
authors.lastname: Chowdhury
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
authors.forename: Paul A
authors.initials: PA
authors.lastname: Law
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology; D012720:Severity of Illness Index