Neonates presenting with temperature symptoms: Role in the diagnosis of early onset sepsis

Abstract

In this study, we aimed to evaluate the role of fever, hypothermia, and temperature instability in term and preterm newborns during the first 3 days of life and to identify risk factors for early onset sepsis (EOS) among newborns presenting with these temperature symptoms. In this retrospective cohort study set in our level III neonatal intensive care unit, we included all newborns hospitalized within the first 24 h of life from 2004 to 2007. Of 851 newborns, 127 presented with temperature symptoms during the first 3 days of life (15%): 69 had fever, 69 had hypothermia, and 55 had temperature instability (8%, 8%, and 6%, respectively). Of 127 newborns presenting with temperature symptoms, 14 had culture-proven EOS/pneumonia (33% of all 42 newborns with culture-proven EOS/pneumonia), 67 had clinical EOS (30% of all 209 newborns with clinical EOS) and 46 were EOS-negative (8% of all 600 EOS-negatives). Factors associated with culture-proven EOS/pneumonia in newborns presenting with temperature symptoms were maternal fever (P = 0.009), chorioamnionitis (P < 0.001), antibiotic therapy of the mother (P = 0.04), poor skin color (P = 0.001) and syndrome of persistent fetal circulation (P = 0.01). Every seventh newborn hospitalized at our neonatal intensive care unit developed fever, hypothermia and/or temperature instability during the first 3 days of life. Two-thirds of them had culture-proven or clinical sepsis. Temperature symptoms were rarely observed in EOS-negative newborns (8%) but despite low sensitivity, were highly specific for bacterial infection in preterm and term newborns.