Association between sepsis calculator and infection parameters for newborns with suspected early onset sepsis

Niek B Achten, Rens Zonneveld, Ellen Tromp, Frans B Plötz

Journal of Clinical Neonatology 2017 6(3):159-162

Context: Early-onset sepsis remains an important clinical problem with significant antibiotic overtreatment as a result of poor specificity of clinical and infection parameters. Quantitative risk stratification models such as the early-onset neonatal sepsis (EOS) calculator are promising, but it is unclear how these models relate to infection parameters in the first 72 h of life. Aim: The aim of this study is to evaluate the hypothesis that higher EOS calculator results are associated with (serial) laboratory infection parameters, in particular an increase in C-reactive protein (CRP) within 24–48 h and low leukocyte counts. Subjects and Methods: EOS risk estimates were determined for infants born ≥34 weeks of gestation who were started on antibiotic treatment for suspected EOS within 72 h after birth. EOS risk estimates were retrospectively compared to (changes in) available laboratory infection parameters, including CRP, leukocyte, and thrombocyte count. Statistical Analysis Used: Spearman's rho rank correlations coefficient was used when testing for correlations between continuous parameters. Kruskal–Wallis and Mann–Whitney U-tests were applied to differences between stratified risk groups. Results: EOS risk was not correlated with changes in infection parameters. We found negative correlations between both EOS risk and CRP level and leukocyte count within 6 h of the start of antibiotics, as well as CRP level between 6 and 24 h after start of treatment. Conclusions: In contrast to our hypothesis, high EOS risk at birth was consistently correlated with lower CRP and leukocyte counts within 24 h after the start of antibiotics, but not with infection parameters after 24 h. Further interpretation of infection parameters during sepsis calculator use needs to be elucidated.

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