The role of elevated central-peripheral temperature difference in early detection of late-onset sepsis in preterm infants
| Autor: | Ulrich Thome, M. Knüpfer, Corinna Gebauer, F. Pulzer, M. Ussat, C. Vogtmann |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Neonatal intensive care unit Infant Premature Diseases Gastroenterology Body Temperature Sepsis Internal medicine medicine Humans Blood culture Prospective Studies Prospective cohort study medicine.diagnostic_test biology business.industry C-reactive protein Infant Newborn Infant Obstetrics and Gynecology Odds ratio medicine.disease Capillary refill Confidence interval Early Diagnosis Pediatrics Perinatology and Child Health biology.protein Female business Infant Premature |
| Zdroj: | Early Human Development. 91:677-681 |
| ISSN: | 0378-3782 |
| DOI: | 10.1016/j.earlhumdev.2015.09.007 |
| Popis: | Aims The study investigated the association between clinical symptoms and late-onset sepsis (LOS) in preterm infants with the aim of identifying a non-invasive tool for the early detection of LOS. Methods This was a prospective study of 83 episodes of suspected LOS in 67 preterm infants. At the time LOS was suspected, we recorded a standardized set of clinical symptoms. A diagnosis of “clinical LOS” (Clin-LOS), “culture-proven LOS” (Prov-LOS) or “LOS not present” (No-LOS) was made on the basis of C-reactive protein (CrP) and blood culture results where Clin-LOS was defined as CrP > 10 mg/l, Prov-LOS was defined as CrP > 10 mg/l AND positive blood cultures, or it was established that there was no sepsis present (No-LOS). We examined univariable associations between clinical signs and LOS using odds ratio (OR) analysis and then adjusted the odds ratio (adOR) through binary regression analysis. Results Clin-LOS was diagnosed in 20/83 episodes, 19 cases were found to have Prov-LOS. Clinical signs which had a significant association with Clin-LOS were capillary refill time > 2 s (OR 2.9) and decreased responsiveness (OR 5.2), whereas there was a negative association between gastric residuals and LOS (OR 0.35). However, the most marked association was found for a greater central-peripheral temperature difference (cpTD) > 2 °C (OR 9). In Prov-LOS an increased heart rate (OR 3.1), prolonged capillary refill time (OR 3.3) and again an increased cpTD (OR 16) had a significant association with LOS, whereas gastric residuals were negatively associated (OR 0.29). Regression analysis showed that cpTD was the most striking clinical sign associated with both Clin- (adOR 6.3) and Prov-LOS (adOR 10.5). Conclusions Prolonged capillary refill time and – more impressive – elevated cpTD were the most useful clinical symptoms for detection of LOS in preterm infants. We especially suggest using cpTD as a predictor of LOS. It is a cheap, non-invasive and readily available tool for daily routines. |
| Databáze: | OpenAIRE |
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