Neonatal Sepsis: What's the Best Test?
Sydney Fitzpatrick and Sabrina Opiola-McCauley
Problem: Neonatal sepsis is a significant cause of mortality and morbidity in the newborn. The vague clinical presentation can be a challenge to the pediatric nurse clinician, often causing a delay in diagnosis and management.
Eligibility Criteria: Thirty-two articles, as well as guidelines and relevant texts, addressing late-onset neonatal sepsis and neonatal sepsis within the last 10 years were selected for review.
Results: When predicting late onset sepsis in the neonate the complete blood count (CBC) with differential showed poor sensitivity and specificity; however, the white blood cells (WBC) showed a good negative predictive value (NPV), along with an I:T ratio of >0.2, strongly indicating bacteremia in a neonate. In terms of inflammatory biomarkers, C-reactive protein (CRP) and procalcitonin (PCT) showed the most promise, with good sensitivity and specificity, as well as good accessibility, when compared to interleukin 6 (IL-6) and serum amyloid A (SAA). DNA polymerase chain reaction (PCR) shows promise.
Conclusions: Many sepsis treatment protocols include the CBC with differential as a main diagnostic test; however, this lacks accuracy in the neonatal population. The emergence of acute phase reactants and inflammatory biomarkers has provided additional diagnostic options in the diagnoses of neonatal sepsis.
Implications: The pediatric nurse clinician should be aware of what tests are available in the clinical setting, and through the use of clinical assessment and history taking in combination with appropriate diagnostics, aim to diagnose these newborns cautiously in accordance with current practice guidelines and protocols.