519 Predictive Value of Clinical Signs in Late-Onset Sepsis (LOS) in Preterm Neonates

Abstract

Background: Accurate diagnosis of LOS in preterm neonates is a major challenge because clinical signs are aspecific leading to unnecessary antibiotic treatment. Aims: To determine the predictive value of clinical signs for identifying LOS in preterm infants. Methods: In all patients 2 seconds, dys/tachypnea, increasing oxygen-need, tachycardia, thermal instability, hyper/hypothermia, feeding difficulties, increasing apnoeic spells, lethargy and irritability) and 4 risk factors (gestational age (GA), weight, sex, central venous catheter (CVC), mechanical ventilation, postnatal age) were prospectively assessed. LOS was defined as bloodculture-proven sepsis occurring after 3 days of age. Results: LOS was diagnosed in 28% of 180 episodes of suspected infection, occurring in 142 neonates (mean GA 30+3 ±2+2 weeks). Only 3 signs were significantly associated with LOS: deterioration of respiratory condition (OR 3,2;95%CI 1,6-6,3), capillary refill >2 seconds (OR 2,9;95%CI 1,5- 5,7) and lethargy (OR 4,4;95%CI 2,2-8,7). Multiple regression resulted in a model with these 3 signs and the presence of a CVC (AUC 0,828; 95%CI 0,764-0,892, p< 0,001). In the absence of these 4 factors, LOS was found in 2,3% (1/43). In case of one or more of the 4 factors sensitivity was 98%, specificity 32%, positive LR 1,45 and negative LR 0,06. Conclusion: Deterioration of respiratory condition, capillary refill, lethargy and the presence of a CVC are the most important clinical signs in predicting LOS in preterm infants. In the absence of all these signs probably antibiotics can be safely withheld.