Diagnosis of Neonatal Late-Onset Infection in Very Preterm Infant: Inter-Observer Agreement and International Classifications.

Gaelle Bury,Stéphanie Leroux,Delphine Mitanchez,Christèle Gras Leguen,Cristhyne Leon Borrego,Patrick Pladys,Alain Beuchée,Guy Carrault,Aurore Thollot,Jean Michel Roué,Geraldine Gascoin

doi:10.3390/ijerph18030882

Abstract

Background: The definition of late-onset bacterial sepsis (LOS) in very preterm infants is not unified. The objective was to assess the concordance of LOS diagnosis between experts in neonatal infection and international classifications and to evaluate the potential impact on heart rate variability and rate of “bronchopulmonary dysplasia or death”. Methods: A retrospective (2017–2020) multicenter study including hospitalized infants born before 31 weeks of gestation with intention to treat at least 5-days with antibiotics was performed. LOS was classified as “certain or probable” or “doubtful” independently by five experts and according to four international classifications with concordance assessed by Fleiss’s kappa test. Results: LOS was suspected at seven days (IQR: 5–11) of life in 48 infants. Following expert classification, 36 of them (75%) were considered as “certain or probable” (kappa = 0.41). Following international classification, this number varied from 13 to 46 (kappa = −0.08). Using the expert classification, “bronchopulmonary dysplasia or death” occurred less frequently in the doubtful group (25% vs. 78%, p < 0.001). Differences existed in HRV changes between the two groups. Conclusion: The definition of LOS is not consensual with a low international and moderate inter-observer agreement. This affects the evaluation of associated organ dysfunction and prognosis.

Highlights

60 preterm infants born before 31 weeks gestation who had received more than five days of antibiotics were included in the Digi-NewB cohort
Twelve patients were excluded from the current study because nine had received antibiotics started before 48 h of life, and three had not enough data available at the time of the suspected infection to be reliably characterized
Early-onset sepsis was suspected at birth in 14 infants

Summary

Introduction

Late-onset sepsis (LOS), occurring after 48 h, 72 h or 7 days of life according to definitions, is a common complication of prematurity. The. The definition of late-onset bacterial sepsis (LOS) in very preterm infants is not unified. The objective was to assess the concordance of LOS diagnosis between experts in neonatal infection and international classifications and to evaluate the potential impact on heart rate variability and rate of “bronchopulmonary dysplasia or death”. “doubtful” independently by five experts and according to four international classifications with concordance assessed by Fleiss’s kappa test. 36 of them (75%) were considered as “certain or probable” (kappa = 0.41). Following international classification, this number varied from 13 to 46

Methods

Results

Discussion

Conclusion