Yenidoğan sepsis tanısında EMA, Töllner ve Rodwell skorlarının değerlendirilmesi

Year 2024, Volume: 17 Issue: 4, 746 - 754, 09.10.2024

Özmert M.a. Özdemir , Büşra Erdal , Musa Turgut

https://doi.org/10.31362/patd.1457265

Abstract

Amaç: Yenidoğan döneminde sepsis tanısını kesin olarak saptayacak özgün belirti, bulgu ve hızlı laboratuvar testleri bulunmamaktadır. Bu nedenle bu çalışmada yenidoğan sepsisinin erken tanısında EMA (European Medicines Agency), Töllner ve Rodwell hematolojik skorlamalarının klinik yeterlilik ve güvenirliğini araştırmayı planladık.
Yöntem: Her hastaya EMA, Töllner ve Rodwell hematolojik skorlaması yapıldı. Sepsis düşünülen yenidoğan bebeklerin tam kan sayımı, periferik yayma, C-reaktif protein, prokalsitonin, kan gazı ve kan şekeri değerleri kaydedildi, bebeklerden alınan kan kültürü, idrar kültürü ve gerekli hallerde alınmış beyin omurilik sıvı incelemesi ve kültürleri değerlendirildi. İstatistiksel analizler kullanılarak skorlamaların ‘Pozitif Beklenen Değer ve Negatif Beklenen Değerler’ oranları elde edildi, performans sonuçları incelendi.
Bulgular: Klinik sepsis ön tanısı alan 95 yenidoğan çalışmaya alındı. Bu bebekler kan kültürü sonuçlarına göre klinik (n:71) ve kanıtlanmış sepsis (n:24) olmak üzere iki gruba ayrıldı. Kesin sepsis tanısında skorlama sistemlerinin pozitif ve negatif prediktif değerleri; sırasıyla EMA için; %21,5, %56,3, Töllner için; %31,3, %77,8, Rodwell için ise %100, %77,8 saptandı.
Sonuç: Çalışmamız, yenidoğan sepsis tanısında klinisyen görüşünün ve standart laboratuvar testlerin sınırlı olduğunu, Rodwell hematolojik skorlamasının diğer iki skorlamaya göre kanıtlanmış sepsisi tanımada daha ön planda olduğunu göstermiştir

Keywords

Sepsis, yenidoğan, EMA, Töllner, Rodwell

Evaluation of EMA, Töllner and Rodwell scores in the diagnosis of neonatal sepsis

Abstract

Purpose: There are no specific signs, symptoms and rapid laboratory tests to definitively diagnose sepsis in the neonatal period. Therefore, in this study, we planned to investigate the clinical adequacy and reliability of EMA (European Medicines Agency), Töllner and Rodwell hematological scoring in the early diagnosis of neonatal sepsis.
Materials and methods: EMA, Töllner and Rodwell hematological scoring was performed on each patient. Complete blood count, peripheral smear, C-reactive protein, procalcitonin, blood gas and blood sugar values of newborn babies with suspected sepsis were recorded, blood culture, urine culture and cerebrospinal fluid examination and cultures taken when necessary were evaluated. Using statistical analysis, the 'Positive Expected Value and Negative Expected Values' ratios of the scores were obtained, and the performance results were examined.
Results: 95 newborns with a preliminary clinical diagnosis of sepsis were included in the study. These babies were divided into two groups: clinical (n:71) and proven sepsis (n:24) according to blood culture results. Positive and negative predictive values of scoring systems in definitive sepsis diagnosis; for EMA respectively; 21.5%, 56.3% for Töllner; It was determined as 31.3%, 77.8%, and 100%, 77.8% for Rodwell.
Conclusion: Our study showed that clinician opinion and standard laboratory tests are limited in the diagnosis of neonatal sepsis, and Rodwell hematological scoring is more prominent in recognizing proven sepsis compared to the other two scores.

Keywords

Sepsis, newborn, EMA, Töllner, Rodwell

References

• 1. Satar M, Engin Arısoy A, Çelik İH. Turkish neonatal society guideline on neonatal infections-diagnosis and treatment. Turk Pediatri Ars 2018;53:88-100. https://doi.org/10.5152/TurkPediatriArs.2018.01809
• 2. Haslam BD. Epidemiology of infection. In: Kliegman RM, Blum NJ, Shah SS, eds. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier 2020:996-1005.
• 3. Stovall SH, Hoffman MA. Bacteremia, Sepsis, and Septic Shock. In: Kline MW, Blaney SM, Giardino Ap, eds. Rudolph's pediatrics. 23rd ed. McGraw-Hill Education 2018:3295-3304.
• 4. Embree JE, Alfattoh NI. Infections in the newborn. In: MacDonald MG, Seshia MMK, eds. Avery's neonatology pathophysiology and management of the newborn. 7th ed. Philadelphia: Wolters Kluwer 2016:930-982.
• 5. Weinberg GA. Infections of Organ Systems. In: Chess PR, ed. Avery's neonatology board review certification and clinical refresher. 1st ed. Philadelphia: Elsevier 2019:273-281.
• 6. Clinical features, evaluation, and diagnosis of sepsis in term and late preterm infants. Available at: https://www.uptodate.com/contents/clinical-features-evaluation-and-diagnosis-of-sepsis-in-term-and-late-preterm-neonates. Accessed March 04, 2022
• 7. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017;390:1770-1780. https://doi.org/10.1016/S0140-6736(17)31002-4
• 8. Satar M, Arısoy AE, Çelik İH. Türk neonatoloji derneği yenidoğan enfeksiyonları tanı ve tedavi rehberi 2023 güncellemesi. Available at: https://neonatology.org.tr/tani-tedavi-protokolleri. Accessed December 9, 2023
• 9. Edwards MS, Baker CJ. Sepsis in the newborn. In: Gershon AA, Hotez PJ, Katz SL, eds. Krugman's infectious diseases of children. 11th ed. Philadelphia:Mosby 2004:545-561.
• 10. Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am 2004;51:939-959. https://doi.org/10.1016/j.pcl.2004.03.009
• 11. Embree JE, Alfattoh NI. Infections in the newborn. In: MacDonald MG, Seshia MMK, eds. Avery's neonatology pathophysiology and management of the newborn. 7th ed. Philadelphia: Wolters Kluwer 2016:930-982.
• 12. Saldir M, Tunc T, Cekmez F, et al. Endocan and soluble triggering receptor expressed on myeloid cells-1 as novel markers for neonatal sepsis. Pediatr Neonatol 2015;56:415-421. https://doi.org/10.1016/j.pedneo.2015.03.006
• 13. Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr 1988;112:761-767. https://doi.org/10.1016/s0022-3476(88)80699-1
• 14. European Medicines Agency (EMA). Report on the Expert Meeting on Neonatal and Paediatric Sepsis. London: 2010. Available at: https://www.ema.europa.eu/en/documents/report/reportexpert-meeting-neonatal-paediatric-sepsis_en.pdf. Accessed April 13, 2020
• 15. Narasimha A, Harendra Kumar ML. Significance of hematological scoring system (HSS) in early diagnosis of neonatal sepsis. Indian J Hematol Blood Transfus 2011;27:14-17. https://doi.org/10.1007/s12288-010-0050-2
• 16. Makkar M, Gupta C, Pathak R, Garg S, Mahajan NC. Performance evaluation of hematologic scoring system in early diagnosis of neonatal sepsis. J Clin Neonatol 2013;2:25-29. https://doi.org/10.4103/2249-4847.109243
• 17. Tuzun F, Ozkan H, Cetinkaya M, et al. Is European Medicines Agency (EMA) sepsis criteria accurate for neonatal sepsis diagnosis or do we need new criteria? PLoS One 2019;14:e0218002. https://doi.org/10.1371/journal.pone.0218002
• 18. Putri VR, Lubis BM, Lubis IND. Effectiveness of Tollner’s score and procalcitonin for diagnosing neonatal sepsis. IJISRT 2022;7:947-950. https://doi.org/10.5281/zenodo.6974466