Neonates presenting with temperature symptoms: Role in the diagnosis of early onset sepsis

Pediatrics International, 04/24/2012

Hofer N et al. – Every seventh newborn hospitalized at neonatal intensive care unit developed fever, hypothermia and/or temperature instability during the first 3 days of life. Two–thirds of them had culture–proven or clinical sepsis. Temperature symptoms were rarely observed in early onset sepsis (EOS)–negative newborns (8%) but despite low sensitivity, were highly specific for bacterial infection in preterm and term newborns.

Methods

  • In this retrospective cohort study set in level III neonatal intensive care unit, they included all newborns hospitalized within the first 24 h of life from 2004 to 2007.

Results

  • Of 851 newborns, 127 presented with temperature symptoms during the first 3 days of life (15%): 69 had fever, 69 had hypothermia, and 55 had temperature instability (8%, 8%, and 6%, respectively).
  • Of 127 newborns presenting with temperature symptoms, 14 had culture-proven EOS/pneumonia (33% of all 42 newborns with culture-proven EOS/pneumonia), 67 had clinical EOS (30% of all 209 newborns with clinical EOS) and 46 were EOS-negative (8% of all 600 EOS-negatives).
  • Factors associated with culture-proven EOS/pneumonia in newborns presenting with temperature symptoms were maternal fever (P= 0.009), chorioamnionitis (P < 0.001), antibiotic therapy of the mother (P= 0.04), poor skin color (P= 0.001) and syndrome of persistent fetal circulation (P= 0.01).

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