title: The role of elevated central-peripheral temperature difference in early detection of late-onset sepsis in preterm infants.
abstract: OBJECTIVE
  The study investigated the association between clinical symptoms and late-onset sepsis (LOS) in preterm infants with the aim of identifying a non-invasive tool for the early detection of LOS.
  
  
  METHODS
  This was a prospective study of 83 episodes of suspected LOS in 67 preterm infants. At the time LOS was suspected, we recorded a standardized set of clinical symptoms. A diagnosis of "clinical LOS" (Clin-LOS), "culture-proven LOS" (Prov-LOS) or "LOS not present" (No-LOS) was made on the basis of C-reactive protein (CrP) and blood culture results where Clin-LOS was defined as CrP>10mg/l, Prov-LOS was defined as CrP>10mg/l AND positive blood cultures, or it was established that there was no sepsis present (No-LOS). We examined univariable associations between clinical signs and LOS using odds ratio (OR) analysis and then adjusted the odds ratio (adOR) through binary regression analysis.
  
  
  RESULTS
  Clin-LOS was diagnosed in 20/83 episodes, 19 cases were found to have Prov-LOS. Clinical signs which had a significant association with Clin-LOS were capillary refill time >2s (OR 2.9) and decreased responsiveness (OR 5.2), whereas there was a negative association between gastric residuals and LOS (OR 0.35). However, the most marked association was found for a greater central-peripheral temperature difference (cpTD) >2°C (OR 9). In Prov-LOS an increased heart rate (OR 3.1), prolonged capillary refill time (OR 3.3) and again an increased cpTD (OR 16) had a significant association with LOS, whereas gastric residuals were negatively associated (OR 0.29). Regression analysis showed that cpTD was the most striking clinical sign associated with both Clin- (adOR 6.3) and Prov-LOS (adOR 10.5).
  
  
  CONCLUSIONS
  Prolonged capillary refill time and - more impressive - elevated cpTD were the most useful clinical symptoms for detection of LOS in preterm infants. We especially suggest using cpTD as a predictor of LOS. It is a cheap, non-invasive and readily available tool for daily routines.
authors.affiliation: Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ussat
authors.affiliation: Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Vogtmann
authors.affiliation: Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Gebauer
authors.affiliation: Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Pulzer
authors.affiliation: Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Thome
authors.affiliation: Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany. Electronic address: knuem@medizin.uni-leipzig.de.
authors.forename: M
authors.initials: M
authors.lastname: Knüpfer
mesh_terms: D001831:Body Temperature / Q000502:physiology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis*
keywords: Central-peripheral temperature difference; Late-onset sepsis; Preterm