Related Experiment Video
Updated: Jun 25, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Sepsis Huddles in the Neonatal Intensive Care Unit: A Retrospective Cohort Study of Late-onset Infection Recognition
Sarah A Coggins1, Leah H Carr2, Mary Catherine Harris3
1Division 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.
Insights
Clinical signs for neonatal sepsis evaluations are often nonspecific. Higher perceived illness severity, not specific signs, correlated with late-onset infection (LOI) in infants, complicating antibiotic stewardship.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Clinical Informatics
Background:
- Late-onset infection (LOI) is a significant concern in neonatal intensive care units (NICUs).
- Accurate identification of infants with LOI is crucial for timely treatment and improved outcomes.
- Current sepsis evaluation protocols rely on clinical signs, but their predictive value for LOI needs further investigation.
Purpose of the Study:
- To analyze the relationship between clinical signs prompting sepsis evaluations, perceived illness severity, and the presence of culture-confirmed LOI in neonates.
- To evaluate the predictive accuracy of specific clinical signs and overall illness severity assessments in identifying LOI.
Main Methods:
- Retrospective cohort study of infants (≥3 days old) admitted to a level IV NICU between September 2018 and May 2021 who underwent a sepsis huddle and LOI evaluation.
- Data extracted from electronic health records included clinical signs, illness severity (green, yellow, red), and management plans.
- Diagnostic test statistics, ROC analyses, and multivariable logistic regression were used to assess relationships between sepsis huddle characteristics and culture-confirmed LOI (bacteremia, UTI, meningitis).
Main Results:
- A total of 1209 sepsis huddles from 604 infants were analyzed; 111 (9%) had culture-confirmed LOI.
- Twelve clinical signs evaluated showed poor discrimination between infants with and without LOI (sensitivity 2-36%, AUROC 0.49-0.53).
- Higher perceived illness severity at the time of the sepsis huddle was associated with increased odds of infection, independent of gestational age and intensive care support.
Conclusions:
- Clinical signs prompting sepsis evaluations in NICU infants are nonspecific and do not reliably predict concurrent LOI.
- Perceived illness severity is a better indicator of infection than specific clinical signs, though misclassification can occur.
- Developing criteria for antibiotic noninitiation in level IV NICUs is challenging due to the similarity of presenting signs in infected and non-infected infants.
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.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...