Journal of Developmental Medicine(Electronic Version)  2021, Vol. 9 Issue (3): 182-187 DOI: 10.3969/j.issn.2095-5340.2021.03.004 |
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| A retrospective study to evaluate the performance of early onset sepsis calculator in neonates born to mothers with clinical chorioamnionitis |
| Zhang Jia, Gao Shuqiang, Hu Xuhong, et al
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Department of Neonatology, Chengdu Women's and Children's Central Hospital, the Affiliated Women's and Children's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan, Chengdu 611731, China
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Abstract 【Abstract】 Objective To evaluate the performance of the early onset sepsis (EOS) risk calculator in
a cohort of neonates born to mothers with clinical chorioamnionitis and compare the performance of the
EOS calculator, clinical signs, and laboratory indicators for correctly identifying EOS. Methods This
was a retrospective study of 121 neonates born to mothers with clinical chorioamnionitis who were admitted to the Department of Neonatology of Chengdu Women's and Children's Central Hospital from January 1, 2018 to November 30, 2019. The risks of EOS and management categories for all neonates were assessed by EOScalculator, and the results were compared with laboratory indicators and clinical signs. Areas under the receiveroperating characteristics curve and sensitivity, specificity, positive and negative predictive values for EOS calculator evaluation results, laboratory indicators and clinical signs were evaluated. Results 121 cases were included in this study, and 71 males and 50 females. The average gestational age was (39.2±1.4) weeks, the average birth weight was (3 344±456) g, and the average highest temperature of the mothers was (38.1±0.6 )℃. There were 16 cases of group B Streptococcus colonization, 23 cases of premature rupture of membranes >18 h, 7 cases of mild asphyxia and 1 case of positive blood culture. According to the management recommendation on the calculator, 97 cases (80.1%) did not need to use antibiotics and blood culture test, 10 cases (8.3%) needed blood culture tests, only14 cases (11.6%) recommended to improve blood culture and use antibiotics at the same time. It showed some efficiency in reducing the rate of antibiotics use and blood culture test. Using the definition of clinical signs from EOS calculator, 74 cases (61.2%) appeared to be asymptomatic, 39 cases (32.2%) of them showed equivocal signs of EOS, and 8 cases (6.6%) had definite signs of clinical illness. The EOS calculator could identify 5 cases of 8 EOS cases, including 1 case with positive blood culture. Three cases of EOS were identified by C-reactive protein and procalcitonin. The
area under the curve of procalcitonin of EOS calculator was 0.795 (95% CI: 0.655-0.934), the sensitivity was62.5%, and the specificity was 80.6%. All the predictive indexes had good negative predictive values, but the positive predictive values were poor. Conclusions EOS calculator can reduce the risk of antibiotic exposure in asymptomatic neonates born to with chorioamnionitis. But it is easy to miss diagnosis. Combined with the detection of blood inflammation indexes, the accuracy of EOS calculator can be improved
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Received: 18 February 2021
Published: 26 May 2021
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