title: Clinical Indicators of Late-Onset Sepsis Workup in Very Low-Birth-Weight Infants in the Neonatal Intensive Care Unit.
abstract: Background Late-onset sepsis (LOS) in very low-birth-weight (VLBW) infants is associated with significant morbidity and mortality. Objectives To determine the incidence of LOS workup, association, and predictive value of clinical indicators leading to culture-positive versus culture-negative sepsis workup. Methods All sepsis workups performed after 7 days of life, in neonates with birth weight of < 1,500 g were included. Each case (culture-positive workup) was matched with a control (culture-negative workup) for gestational age (GA), birth weight, corrected gestational age, and chronological age, at the time of workup. The clinical indicators leading to the performance of sepsis workup were compared between cases and controls. Results The incidence of culture-positive workup was 87/345 (25.2%) and that of LOS was 84/279 (30.1%). Among various clinical indicators, hypothermia and apnea were significantly associated with culture-positive sepsis workup (p = 0.015 and 0.004, respectively), with a positive predictive value of 81.2 and 71.4%, respectively. Conclusion In VLBW infants, one-fourth of sepsis workups resulted in a positive culture. Apnea and hypothermia were the most significant predictors of culture-positive workup after matching for GA, birth weight, chronological age, and corrected GA at the time of the workup.
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Anirudha
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Sonia
authors.initials: S
authors.lastname: Shukla
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Nazia
authors.initials: N
authors.lastname: Rahman
authors.affiliation: Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, Ohio.
authors.forename: Douglas
authors.initials: D
authors.lastname: Gunzler
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Nazha
authors.initials: N
authors.lastname: Abughali
mesh_terms: D001049:Apnea / Q000209:etiology; D000071997:Blood Culture; D016022:Case-Control Studies; D002555:Cerebrospinal Fluid / Q000382:microbiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D000071074:Neonatal Sepsis / Q000453:epidemiology* / Q000503:physiopathology*; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013210:Staphylococcus / Q000302:isolation & purification*; D014556:Urine / Q000382:microbiology