Rodríguez-Rojo LA, Barrera-De León JC, Maldonado-González JG, Bautista-Vásquez Á, Yerenas-Esparza EM, Ibarra-Hernández FA

Language: Spanish
References: 20
Page: 261-268
PDF size: 153.49 Kb.

ABSTRACT

Introduction. Nosocomial sepsis in premature neonates entertains a high rate of mortality. Diagnosis and timely treatment increase the therapeutic response. The nosocomial sepsis neonate prediction (NOSEP-1) scale has been utilized to evaluate neonatal sepsis; this scale required modifications to improve its sensitivity and specificity (NOSEP-1 modified). Objective. To determine the diagnostic usefulness of the NOSEP-1 and NOSEP-1 modified scales when nosocomial sepsis is suspected in premature neonates. Material and methods. Evaluation of the diagnostic test in premature neonates with data suggestive of sepsis. The gold standard was the hemoculture and the following diagnostic tests: nosocomial sepsis neonate prediction (NOSEP-1), with the following five items, including C-reactive protein (CRP); neutrophils; platelets; evaluation of the 24-h parenteral nutrition test, and fever, while NOSEP-1 modified substitutes fever with thermal stability and days on parenteral nutrition are reduced from 14 to 3 days. Precision, sensitivity, specificity, and positive and negative predictive values were calculated. The Fagan nomogram determined diagnostic usefulness. We employed the SSPS ver. 20 statistical software Packaged and statistical significance of p ‹ 0.05. Results. We studied 77 premature neonates, with application of the gold standard and the diagnostic test. There were 36 (47%) positive hemocultures. NOSEP-1, › 9 in sepsis 24 (67%), without sepsis 15 (36%) (p = 0.012). NOSEP-1 modified, › 9 in sepsis 35 (97%), without sepsis 35 (88%) (p = 0.113). NOSEP-1: sensitivity, 66%; specificity, 63%; positive pressure volume (PPV), 61%; negative pressure volume (NPV), 68%; positive pressure rate (RPP), 1.82, and negative pressure rate (RPN), 1.14. NOSEP-1 modified scale: sensitivity 97%; specificity 14%; positive pressure value (PPV), 50%; negative pressure value (NPV), 85%; positive probability ratio (PPR), 0.53, and negative probability ratio (NPR), 0.19. Diagnostic usefulness: NOSEP-1, 64%, and NOSEP-1 Modified, 53%. Conclusions. The NOSEP-1 and the modified NOSEP-1 scales have limited usefulness for diagnosing nosocomial sepsis in premature neonates.

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