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Journal of Tropical Pediatrics Advance Access published online on July 21, 2009
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmp061
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© The Author [2009]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Nosocomial Sepsis Risk Score for Preterm Infants in Low-resource Settings

Rebecca E. Rosenberga, ASM Nawshad U. Ahmedb,c, Samir K. Sahad, MAK Azad Chowdhuryc, Saifuddin Ahmede, Paul A. Lawf, Robert E. Blacka, Mathuram Santoshama and Gary L. Darmstadta

a Department of International Health, International Center for Advancing Neonatal Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
b Department of Pediatrics, Kumudini Women's Medical College, Mirzapur, Tangail, Bangladesh
c Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
d Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
e Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
f Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA

Correspondence: Mathuram Santosham, Integrated Health Solutions Development, Global Health Program, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, WA 98102, USA, 206-494-7040. E-mail <gary.darmstadt{at}gatesfoundation.org>.


  Abstract

Sepsis is a leading cause of mortality for neonates in developing countries; however, little research has focused on clinical predictors of nosocomial infection of preterm neonates in the low-resource setting. We sought to validate the only existing feasible score introduced by Singh et al. in 2003 and to create an improved score. In a secondary analysis of daily evaluations of 497 neonates ≤33 weeks gestational age admitted to a tertiary care NICU in Dhaka, Bangladesh, we tested the Singh score and then constructed and internally validated our own bedside predictive score. The Singh score had low sensitivity of 56.6% but good positive predictive value (PPV) of 78.1% in our sample. Our five-sign model requiring at least one clinical sign of infection (apnea, hepatomegaly, jaundice, lethargy and pallor) had an area under the receiver operating characteristic of 0.70, sensitivity of 77.1%, and PPV of 64.9%. Our clinical sepsis score is the first bedside clinical screen exclusively for hospitalized, very premature neonates in a low-resource setting, and warrants external validation.

Key Words: neonate • sepsis • prematurity • very low birth-weight • developing countries • nosocomial


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