Can We Estimate Late-Onset Sepsis by Serial Methemoglobin Levels? An Observational Study in Preterm Neonates

Area of Science:

• Neonatal Medicine
• Clinical Pathology
• Pediatric Infectious Diseases

Background:

• Late-onset sepsis (LOS) is a significant cause of morbidity and mortality in preterm infants.
• Early and accurate diagnosis of LOS is crucial for timely intervention and improved outcomes.
• Current diagnostic methods may have limitations in speed and sensitivity.

Purpose of the Study:

• To evaluate serial methemoglobin (MetHb) levels as a potential diagnostic biomarker for LOS in preterm neonates.
• To determine the correlation between MetHb levels and the presence and severity of LOS.
• To assess the utility of MetHb in predicting mortality in preterm infants with LOS.

Main Methods:

• A comparative study design involving preterm infants diagnosed with culture-proven LOS and a control group.
• Serial measurements of MetHb levels were performed in both groups.
• Statistical analysis was used to compare MetHb levels and determine diagnostic and prognostic cutoffs.

Main Results:

• Preterm infants with LOS exhibited significantly elevated MetHb levels compared to controls (p < 0.001).
• A MetHb cutoff of >1.75% demonstrated high sensitivity (81.9%) and specificity (90%) for LOS detection.
• Decreased MetHb levels were observed following successful antimicrobial therapy (p < 0.001).
• MetHb levels >2% were associated with increased mortality in LOS patients (AUC 0.810, p < 0.005).

Conclusions:

• MetHb levels rise during the onset of LOS in preterm infants and decline with effective treatment.
• MetHb serves as a rapid indicator of infectious processes and can complement existing sepsis biomarkers.
• Elevated MetHb (>2%) is a significant predictor of mortality in preterm neonates with LOS.