Time for a Neonatal-Specific Consensus Definition for Sepsis
There is remarkable heterogeneity among studies regarding the definition of neonatal sepsis (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/PCC/A102). For example, in 12 of 42 selected studies/guidelines (29%), single or combinations of laboratory tests were incorporated into the definition of sepsis and included C-reactive protein (n = 5), total WBC (n = 4), metabolic acidosis (n = 3), unspecified laboratory studies (n = 2), immature to total neutrophil (I/T) ratio (n = 3), neutropenia (n = 1), abnormal fibrinogen (n = 1), thrombocytopenia (n = 1), hyperglycemia (n = 1), and hypoglycemia (n = 1). In many cases, there was additional variability among laboratory results defined as abnormal. Clinical findings were integrated in 26 of 42 of the selected studies/guidelines (62%) and included unspecified signs of sepsis (n = 16), cardiovascular signs (tachycardia/bradycardia, hypotension, and poor perfusion [n = 12]), respiratory signs (apnea, cyanosis, tachypnea, need for ventilator, and increased oxygen requirement [n = 9]), abnormal temperature (fever or hypothermia [n = 7]), CNS signs (lethargy, hypotonia, and seizure [n = 2]), and feeding problems (n = 1). In some reports, neonatal sepsis was defined by the duration of antimicrobial treatment (at least 5 or more days). Thus, there is an unmet need for the development of a consensus definition for sepsis in both preterm and term neonates to be used for future clinical studies.
The pediatric consensus definition of sepsis is SIRS in the presence of or as a result of suspected or proven infection. SIRS requires either 1) abnormal white count (total WBC increased or decreased for age or more than 10% immature neutrophils) or 2) abnormal core temperature (> 38.5°C or < 36°C). Because abnormal WBC indices or an abnormal core temperature are required for the definition of SIRS, we will focus on the predictive accuracy of these tests in term and preterm neonates.
How Has Sepsis Been Defined in Neonates?
There is remarkable heterogeneity among studies regarding the definition of neonatal sepsis (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/PCC/A102). For example, in 12 of 42 selected studies/guidelines (29%), single or combinations of laboratory tests were incorporated into the definition of sepsis and included C-reactive protein (n = 5), total WBC (n = 4), metabolic acidosis (n = 3), unspecified laboratory studies (n = 2), immature to total neutrophil (I/T) ratio (n = 3), neutropenia (n = 1), abnormal fibrinogen (n = 1), thrombocytopenia (n = 1), hyperglycemia (n = 1), and hypoglycemia (n = 1). In many cases, there was additional variability among laboratory results defined as abnormal. Clinical findings were integrated in 26 of 42 of the selected studies/guidelines (62%) and included unspecified signs of sepsis (n = 16), cardiovascular signs (tachycardia/bradycardia, hypotension, and poor perfusion [n = 12]), respiratory signs (apnea, cyanosis, tachypnea, need for ventilator, and increased oxygen requirement [n = 9]), abnormal temperature (fever or hypothermia [n = 7]), CNS signs (lethargy, hypotonia, and seizure [n = 2]), and feeding problems (n = 1). In some reports, neonatal sepsis was defined by the duration of antimicrobial treatment (at least 5 or more days). Thus, there is an unmet need for the development of a consensus definition for sepsis in both preterm and term neonates to be used for future clinical studies.
The pediatric consensus definition of sepsis is SIRS in the presence of or as a result of suspected or proven infection. SIRS requires either 1) abnormal white count (total WBC increased or decreased for age or more than 10% immature neutrophils) or 2) abnormal core temperature (> 38.5°C or < 36°C). Because abnormal WBC indices or an abnormal core temperature are required for the definition of SIRS, we will focus on the predictive accuracy of these tests in term and preterm neonates.