The role of elevated central-peripheral temperature difference in early detection of late-onset sepsis in preterm infants

• Published in: Early human development Vol. 91; no. 12; pp. 677 - 681
• Main Authors: Ussat, M, Vogtmann, C, Gebauer, C, Pulzer, F, Thome, U, Knüpfer, M
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-12-2015
• Subjects: Advanced Basic Science; Body Temperature - physiology; Central-peripheral temperature difference; Early Diagnosis; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - diagnosis; Late-onset sepsis; Male; Neonatal and Perinatal Medicine; Preterm; Prospective Studies; Sepsis - diagnosis; C-reactive protein; CRT; central-peripheral temperature difference; CNS; NICU; odds ratio; adjusted odds ratio; IL-6 & IL-8; I/T ratio; PDA; interleukin 6 and 8; Prov-LOS; coagulase-negative staphylococci; No-LOS; P; cT; clinical late-onset sepsis; patent ductus arteriosus; late-onset sepsis; proven late-onset sepsis; CrP; immature neutrophil to total neutrophil ratio; OR; p-value; pT; capillary refill time; CI; central temperature; peripheral limb temperature; adOR; Preterm; Clin-LOS; LOS; cpTD; neonatal intensive care unit; confidence interval; late-onset sepsis was established to be absent; Late-onset sepsis; Central-peripheral temperature difference
• ISSN: 0378-3782; 1872-6232
• DOI: 10.1016/j.earlhumdev.2015.09.007

Abstract Aims The study investigated the association between clinical symptoms and late-onset sepsis (LOS) in preterm infants with the aim of identifying a non-invasive tool for the early detection of LOS. Methods This was a prospective study of 83 episodes of suspected LOS in 67 preterm infants. At the time LOS was suspected, we recorded a standardized set of clinical symptoms. A diagnosis of “clinical LOS” (Clin-LOS), “culture-proven LOS” (Prov-LOS) or “LOS not present” (No-LOS) was made on the basis of C-reactive protein (CrP) and blood culture results where Clin-LOS was defined as CrP > 10 mg/l, Prov-LOS was defined as CrP > 10 mg/l AND positive blood cultures, or it was established that there was no sepsis present (No-LOS). We examined univariable associations between clinical signs and LOS using odds ratio (OR) analysis and then adjusted the odds ratio (adOR) through binary regression analysis. Results Clin-LOS was diagnosed in 20/83 episodes, 19 cases were found to have Prov-LOS. Clinical signs which had a significant association with Clin-LOS were capillary refill time > 2 s (OR 2.9) and decreased responsiveness (OR 5.2), whereas there was a negative association between gastric residuals and LOS (OR 0.35). However, the most marked association was found for a greater central-peripheral temperature difference (cpTD) > 2 °C (OR 9). In Prov-LOS an increased heart rate (OR 3.1), prolonged capillary refill time (OR 3.3) and again an increased cpTD (OR 16) had a significant association with LOS, whereas gastric residuals were negatively associated (OR 0.29). Regression analysis showed that cpTD was the most striking clinical sign associated with both Clin- (adOR 6.3) and Prov-LOS (adOR 10.5). Conclusions Prolonged capillary refill time and – more impressive – elevated cpTD were the most useful clinical symptoms for detection of LOS in preterm infants. We especially suggest using cpTD as a predictor of LOS. It is a cheap, non-invasive and readily available tool for daily routines.