ABSTRACT
OBJECTIVE: To assess the sensitivity and specificity of neutrophil CD64 as a diagnostic marker for clinical sepsis (based on a hematologic score) and as an additional marker with hematologic parameters for culture-proven sepsis in neonates. STUDY DESIGN: Prospective observational cohort over 18 months in a single-center neonatal intensive care unit. RESULTS: Hematologic and CD64 data were available on 1,156 sepsis evaluations done in 684 infants, of which 411 (36%) instances of positive clinical sepsis were identified. The CD64 index for clinical sepsis had an overall area under the receiver operating characteristic curve of 0.71. An optimum CD64 cut point value of 2.19 for late-onset clinical sepsis was calculated with a sensitivity of 78%, a specificity of 59%, and a negative predictive value of 81%. The birth weight-specific CD64 cut point for early onset clinical sepsis was 3.13, 2.34, and 2.05 for very low, low, and normal birth weight, respectively. Neutrophil CD64, in combination with the absolute neutrophil count or the absolute band count, had the highest sensitivity (91%) and specificity (93%), respectively, to diagnose culture-proven sepsis. CONCLUSION: We conclude that neutrophil CD64 index can be incorporated with specific hematologic criteria as an additional marker for diagnosis of neonatal sepsis.
Subject(s)
Birth Weight , Neutrophils/metabolism , Receptors, IgG/blood , Sepsis/blood , Sepsis/diagnosis , Anti-Bacterial Agents/therapeutic use , Area Under Curve , Biomarkers/blood , Blood/microbiology , Female , Humans , Infant, Newborn , Leukocyte Count , Male , Predictive Value of Tests , Prospective Studies , ROC Curve , Sepsis/drug therapy , Time FactorsABSTRACT
BACKGROUND: The newborn classified as growth-restricted on fetal weight curves, but not on birth weight curves, is classified prenatally as small for gestational age (SGA), but postnatally as appropriate for gestational age (AGA). AIMS: To see (1) to what extent the neurodevelopmental outcomes at 24 months corrected age differed among three groups of infants (those identified as SGA based on birth weight curves (B-SGA), those identified as SGA based on fetal weight curves only (F-SGA), and the referent group of infants considered AGA, (2) if girls and boys were equally affected by growth restriction, and (3) to what extent neurosensory limitations influenced what we found. STUDY DESIGN: Observational cohort of births before the 28th week of gestation. OUTCOME MEASURES: Mental Development Index (MDI) and Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development II. RESULTS: B-SGA, but not F-SGA girls were at an increased risk of a PDI<70 (OR=2.8; 95% CI: 1.5, 5.3) compared to AGA girls. B-SGA and F-SGA boys were not at greater risk of low developmental indices than AGA boys. Neurosensory limitations diminished associations among girls of B-SGA with low MDI, and among boys B-SGA and F-SGA with PDI<70. CONCLUSIONS: Only girls with the most severe growth restriction were at increased risk of neurodevelopmental impairment at 24 months corrected age in the total sample. Neurosensory limitations appear to interfere with assessing growth restriction effects in both girls and boys born preterm.
Subject(s)
Birth Weight , Cognition Disorders/epidemiology , Developmental Disabilities/epidemiology , Fetal Growth Retardation/epidemiology , Fetal Weight , Adult , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Small for Gestational Age , Male , Pregnancy , Sex Factors , Young AdultABSTRACT
We assessed neutrophil CD64 as a diagnostic marker for neonatal sepsis. For early-onset sepsis, the CD64 index with a cut-point value of 2.38 had sensitivity, specificity and negative predictive values of 100%, 68% and 100%, respectively. For late-onset sepsis, the respective values were 3.62, 75%, 77% and 96%. Neutrophil CD64 index can be incorporated as a valuable marker for excluding neonatal sepsis.