Predictive Clinical Score for Early Diagnosis of Late Onset Sepsis

Abstract

Background: Neonatal infections account for 40% of all neonatal deaths in developing countries. There is paucity of data regarding the scoring purely based on clinical signs for the prediction of sepsis and hence the intention of the study is to develop a scoring system for risk predictability and early management     Methods: All neonates developing signs of sepsis beyond 3rd day of life, underwent septic screening, with 2 or more screening parameters positive, blood cultures and csf were drawn and analysed. We calculated sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio of individual sign and constellation of signs. A score was formulated based on these parameters.     Result: Study cohort included 159  neonates with 342 symptomatic events. Respiratory distress, fever, abdominal distension and refusal of feeds were the most common presenting complaints. Abdominal distension had the highest positive predictive value and likelihood ratio and highest score. distention along with Increased abdominal girth and altered gastric aspirate together achieved highest score. E.coli was the most common organism isolated.   Conclusion: The study shows that when ready access to laboratory tests is meagre, the score based on clinical signs can significantly contribute to the diagnosis of late-onset septicemia and its early management and hence improve neonatal survival.