Table 1.
Comparison of various neonatal (age <28 days) nosocomial (hospital stay >48 h) sepsis scores
| Study | Population | Lab or procedure s/sx | S/sx (Trained observer) | Primary outcome (Score threshold, if applicable) |
|---|---|---|---|---|
| Tollner [8] | Hospitalized neonates (Ulm NICU) | pH (<7.2, 7.2–7.4) | Abnormal skin color | Positive culture |
| (Eur J Pediatrics 1982) | Derivation: | WBC (high or low) | Delayed cap refill | (score >4.5) |
| N = 83 | Left shift | Muscular hypotonia | Bradycardia | |
| Testing: | Platelet count <150 000 | Apnea | ||
| N = 584 (predetermined ‘normal babies’ and sick subgroups) | Respiratory distress Hepatomegaly Gastrointestinal symptoms | |||
| Mahieu et al. [9] (Crit Care Med 2002): NOSEP | >48 hol, hospitalized neonates (Antwerp, Belgium NICU) | CRP≥14 mg/l Percentage of neutrophils > 50% Platelet <150 000 | Fever>38.2 °C | Positive culture |
| Derivation n = 559 (110 episodes) | Total parenteral nutrition ≥14 days | |||
| Testing: | ||||
| N = 50 episodes | ||||
| Okascharoen et al. [10] (J Perinat 2005) | >72 hol, hospitalized neonates (Bangkok, Thailand NICU) | Bands >1% Platelet<150 000 Umbilical vein catheterization | Hypotension Abnormal body temperature Respiratory insufficiency | Positive culture |
| Derivation: n = 1870 (100 suspected, 17 proven) | 1–7 days ≥7 days | |||
| Validation: | ||||
| N = 73 suspected | ||||
| Singh et al. [11] (J Trop Peds 2003) | >72 hol, hospitalized neonates (Chandigarh, India NICU) N = 80 babies, 105 episodes | (Weighted score) Lethargy Tachycardia Hyperthermia Abdominal distention Increased aspirates Chest retractions Grunting | Definite (positive culture) or probable sepsis (score ≥1) | |
| Fanaroff et al. [35] | >96 hol, hospitalized neonates | I:T ratio >0.2 | Increased apnea/bradycardia | Positive culture |
| (Pediatr Infect Dis J 1998) | (Various academic hospitals, USA) | WBC>20 000 Neutropenia | Increased mechanical ventilation requirements | |
Hol, hours of life; I:T, ratio of immature to total white cell count; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; WBC, white blood cell count; NICU, neonatal intensive care unit.