title: Central-peripheral temperature gradient: an early diagnostic sign of late-onset neonatal sepsis in very low birth weight infants.
abstract: OBJECTIVE
  We assessed central-peripheral temperature gradient alteration for the diagnosis of late-onset neonatal sepsis and compared earliness detection of this sign with altered blood cell count and C-reactive protein.
  
  
  METHODS
  Thirty-one preterm babies (<1500 g or <32 weeks) participated in an observational prospective study. Axillary (central) and sole (peripheral) temperatures were continuously monitored with a thermal probe (ThermoTracer; Dräger Medical AGF & Co. KgaA, Lübeck, Germany) adjusting incubator air temperature for a thermal gradient <1.5°C. Central-peripheral temperature alteration was defined as a thermal gradient >2°C that could not be corrected with protocolized air temperature modifications. Proven (positive blood culture) sepsis and probable late-onset sepsis were recorded.
  
  
  RESULTS
  Late-onset sepsis was diagnosed in 11 neonates (proven, 9; probable, 2). Thermal gradient alteration was present in 12 cases, in association with the onset of sepsis in 10 and concomitantly with a ductus arteriosus and stage 1 necrotizing enterocolitis in 2. Thermal gradient alteration had a sensitivity of 90.9% [95% confidence interval (CI), 62.3-98.4] and specificity of 90% (95% CI, 69.9-97.2%), and in 80% of cases, it occurred before abnormal laboratory findings.
  
  
  CONCLUSIONS
  Central-peripheral temperature gradient monitoring is a feasible, non-invasive, and simple tool easily applicable in daily practice. An increase of >2°C showed a high-sensitivity and specificity for the diagnosis of late-onset sepsis.
authors.affiliation: Section of Neonatology, Service of Pediatrics, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain. leantejl@yahoo.es
authors.forename: José Luis
authors.initials: JL
authors.lastname: Leante-Castellanos
authors.forename: José M
authors.initials: JM
authors.lastname: Lloreda-García
authors.forename: Ana
authors.initials: A
authors.lastname: García-González
authors.forename: Caridad
authors.initials: C
authors.lastname: Llopis-Baño
authors.forename: Carmen
authors.initials: C
authors.lastname: Fuentes-Gutiérrez
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Alonso-Gallego
authors.forename: Antonio
authors.initials: A
authors.lastname: Martínez-Gimeno
mesh_terms: D001831:Body Temperature; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D019102:Infant, Very Low Birth Weight; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis*