دورية أكاديمية
Sepsis Huddles in the Neonatal Intensive Care Unit: A Retrospective Cohort Study of Late-onset Infection Recognition and Severity Assessment.
| العنوان: | Sepsis Huddles in the Neonatal Intensive Care Unit: A Retrospective Cohort Study of Late-onset Infection Recognition and Severity Assessment. |
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| المؤلفون: | Coggins SA; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: cogginss@chop.edu., Carr LH; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA., Harris MC; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA., Srinivasan L; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania, Philadelphia, PA. |
| المصدر: | The Journal of pediatrics [J Pediatr] 2024 Sep; Vol. 272, pp. 114117. Date of Electronic Publication: 2024 May 28. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Mosby Country of Publication: United States NLM ID: 0375410 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6833 (Electronic) Linking ISSN: 00223476 NLM ISO Abbreviation: J Pediatr Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: St. Louis, MO : Mosby |
| مواضيع طبية MeSH: | Intensive Care Units, Neonatal* , Severity of Illness Index*, Humans ; Retrospective Studies ; Infant, Newborn ; Male ; Female ; Sepsis/diagnosis ; Neonatal Sepsis/diagnosis |
| مستخلص: | Objective: To analyze relationships between provider-documented signs prompting sepsis evaluations, assessments of illness severity, and late-onset infection (LOI). Study Design: Retrospective cohort study of all infants receiving a sepsis huddle in conjunction with a LOI evaluation. Participants were ≥3 days old and admitted to a level IV neonatal intensive care unit (NICU) from September 2018 through May 2021. Data were extracted from standardized sepsis huddle notes in the electronic health record, including clinical signs prompting LOI evaluations, illness severity assessments (from least to most severe: green, yellow, and red), and management plans. To analyze relationships of sepsis huddle characteristics with the detection of culture-confirmed LOI (bacteremia, urinary tract infection, or meningitis), we utilized diagnostic test statistics, area under the receiver-operator characteristic analyses, and multivariable logistic regression. Results: We identified 1209 eligible sepsis huddles among 604 infants. There were 111 culture-confirmed LOI episodes (9% of all huddles). Twelve clinical signs of infection poorly distinguished infants with and without LOI, with sensitivity for each ranging from 2% to 36% and area under the receiver-operator characteristic ranging 0.49-0.53. Multivariable logistic regression identified increasing odds of infection with higher perceived illness severity at the time of sepsis huddle, adjusted for gestational age and receipt of intensive care supports. Conclusions: Clinical signs prompting sepsis huddles were nonspecific and not predictive of concurrent LOI. Higher perceived illness severity was associated with presence of infection, despite some misclassification based on objective criteria. In level IV NICUs, antimicrobial stewardship through development of criteria for antibiotic noninitiation may be challenging, as presenting signs of LOI are similar among infants with and without confirmed infection. Competing Interests: Declaration of Competing Interest LHC is partial owner of 2minutemedicine.com, a medical news and educational website. The authors have no conflicts of interest or financial disclosures relevant to this work. (Copyright © 2024 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: infant; infection; neonate; prediction; recognition; sepsis; sepsis huddle |
| تواريخ الأحداث: | Date Created: 20240530 Date Completed: 20240824 Latest Revision: 20240824 |
| رمز التحديث: | 20240826 |
| DOI: | 10.1016/j.jpeds.2024.114117 |
| PMID: | 38815749 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1097-6833 |
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| DOI: | 10.1016/j.jpeds.2024.114117 |