The role of elevated central-peripheral temperature difference in early detection of late-onset sepsis in preterm infants. Issue 12 (December 2015)

• Record Type: Journal Article
• Authors: Ussat, M.; Vogtmann, C.; Gebauer, C.; Pulzer, F.; Thome, U.; Knüpfer, M.
• Is Part Of: Early human development. Volume 91:Issue 12(2015)
• Page Start: 677
• Page End: 681
• Publication Date: 2015-12
• Subjects: adOR adjusted odds ratio -- CI confidence interval -- Clin-LOS clinical late-onset sepsis -- CNS coagulase-negative staphylococci -- cpTD central-peripheral temperature difference -- CrP C-reactive protein -- CRT capillary refill time -- cT central temperature -- IL-6 & IL-8 interleukin 6 and 8 -- I/T ratio immature neutrophil to total neutrophil ratio -- LOS late-onset sepsis -- NICU neonatal intensive care unit -- No-LOS late-onset sepsis was established to be absent -- OR odds ratio -- P p-value -- PDA patent ductus arteriosus -- Prov-LOS proven late-onset sepsis -- pT peripheral limb temperature; Late-onset sepsis -- Central-peripheral temperature difference -- Preterm; Fetus -- Periodicals; Neonatology -- Periodicals; Prenatal influences -- Periodicals; 612.65
• DOI: 10.1016/j.earlhumdev.2015.09.007
• Languages: English
• ISSNs: 0378-3782

Abstract

Abstract: 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. Highlights: Early detection of late onset sepsis (LOS) in ELBW-infants is still a formidable task. We investigated the association between clinical symptoms and late-onset sepsis (LOS) in 83 episodes of suspected LOS in 67 preterm infants. The most marked association between LOS and symptoms of disturbed circulatory regulation, like prolonged capillary refill time and a greater central-peripheral temperature difference (cpTD) > 2 °C, but not blood pressure changes. So we conclude that 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.