Prognostic factors of mortality in very low-birth-weight infants with neonatal sepsis of nosocomial origin.

OBJECTIVE: To identify the variables associated with sepsis-associated mortality, as well as to develop a severity risk score to predict death in very low-birth-weight (VLBW) neonates affected by nosocomial sepsis. STUDY DESIGN: Retrospective cohort study. Infants weighing ≤ 1500 g with neonatal sepsis of nosocomial origin were included. Epidemiological, clinical, and laboratory variables were recorded at onset (0 hours), at 12 hours, and at 24 hours. Bivariate and multivariate analyses were performed. RESULT: The study population included 95 VLBW infants who presented 129 episodes of nosocomial sepsis. In the bivariate analysis, gram-negative bacilli as the etiology of sepsis, seizures, age, postconceptional age, weight, serum procalcitonin (24 hours), platelet count (24 hours), blood urea nitrogen (0 and 24 hours), creatinine (24 hours), diuresis (12 and 24 hours), mean blood pressure (12 and 24 hours), pH, base excess (0, 12, and 24 hours), and SpO(2) (pulse oximetric saturation):F(IO(2)) (fraction of inspired oxygen) ratio (12 and 24 hours) were significantly associated with mortality. In the multivariate analysis, weight at the onset of sepsis, base excess (0 hours), and SpO(2):F(IO(2)) ratio (12 hours) were independent predictors of mortality. CONCLUSION: A lower weight at the onset of sepsis, base excess, and SpO(2):F(IO(2)) ratio are useful to predict nosocomial sepsis-associated mortality in VLBW infants.

Urinary tract infection in the newborn: clinical and radio imaging studies.

The objective of this study was to assess clinical characteristics and results of radio imaging studies and compare community-acquired urinary tract infection (UTI) with nosocomial UTI in 301 neonates with UTI consecutively admitted to 28 neonatal units in Spain over 3 years (community-acquired UTI, n = 250; nosocomial UTI, n = 51). UTI was diagnosed in the presence of symptoms of infection together with any colony growth for a single pathogen from urine obtained by suprapubic aspiration, or >or=10(4) CFU/ml for a single pathogen from urine obtained by urethral catheterization. Abnormal renal ultrasound was present in 37.1% of cases (34% in community-acquired UTI and 54.5% in nosocomial UTI, P < 0.01). The voiding cystourethrography (VCUG) showed vesicoureteral reflux (VUR) in 27% of cases (23.8% in community-acquired UTI and 48.6% in nosocomial UTI, P < 0.01). In patients with abnormal renal ultrasound and VUR, renal scan with dimercaptosuccinic acid (DMSA) performed early after UTI revealed cortical defects in 69.5% of cases. However, in patients with abnormal renal ultrasound and normal VCUG, DMSA also revealed cortical defects in 39% of cases. The absence of VUR in neonates with UTI and abnormal renal ultrasound does not exclude the presence of cortical defects suggestive of pyelonephritis.

Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission.

BACKGROUND: The results of recent studies suggest the usefulness of PCT for early diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to determine the behavior of serum PCT concentrations in both uninfected and infected neonates, and to assess the value of this marker for diagnosis of neonatal sepsis of vertical transmission. METHODS: PCT was measured in 827 blood samples collected prospectively from 317 neonates admitted to 13 acute-care teaching hospitals in Spain over one year. Serum PCT concentrations were determined by a specific immunoluminometric assay. The diagnostic efficacy of PCT at birth and within 12-24 h and 36-48 h of life was evaluated calculating the sensitivity, specificity, and likelihood ratio of positive and negative results. RESULTS: 169 asymptomatic newborns and 148 symptomatic newborns (confirmed vertical sepsis: 31, vertical clinical sepsis: 38, non-infectious diseases: 79) were studied. In asymptomatic neonates, PCT values at 12-24 h were significantly higher than at birth and at 36-48 h of life. Resuscitation at birth and chorioamnionitis were independently associated to PCT values. Neonates with confirmed vertical sepsis showed significantly higher PCT values than those with clinical sepsis. PCT thresholds for the diagnosis of sepsis were 0.55 ng/mL at birth (sensitivity 75.4%, specificity 72.3%); 4.7 ng/mL within 12-24 h of life (sensitivity 73.8%, specificity 80.8%); and 1.7 ng/mL within 36-48 h of life (sensitivity 77.6%, specificity 79.2%). CONCLUSION: Serum PCT was moderately useful for the detection of sepsis of vertical transmission, and its reliability as a maker of bacterial infection requires specific cutoff values for each evaluation point over the first 48 h of life.