Content area
Full Text
Problem: Neonatal sepsis is a significant cause of mortality and morbidity in the newborn. The vague clinical presentation can be a challenge to the pediatric nurse clinician, often causing a delay in diagnosis and management.
Eligibility Criteria: Thirty-two articles, as well as guidelines and relevant texts, addressing late-onset neonatal sepsis and neonatal sepsis within the last 10 years were selected for review.
Results: When predicting late onset sepsis in the neonate the complete blood count (CBC) with differential showed poor sensitivity and specificity; however, the white blood cells (WBC) showed a good negative predictive value (NPV), along with an I:T ratio of >0.2, strongly indicating bacteremia in a neonate. In terms of inflammatory biomarkers, C-reactive protein (CRP) and procalcitonin (PCT) showed the most promise, with good sensitivity and specificity, as well as good accessibility, when compared to interleukin 6 (IL-6) and serum amyloid A (SAA). DNA polymerase chain reaction (PCR) shows promise.
Conclusions: Many sepsis treatment protocols include the CBC with differential as a main diagnostic test; however, this lacks accuracy in the neonatal population. The emergence of acute phase reactants and inflammatory biomarkers has provided additional diagnostic options in the diagnoses of neonatal sepsis.
Implications: The pediatric nurse clinician should be aware of what tests are available in the clinical setting, and through the use of clinical assessment and history taking in combination with appropriate diagnostics, aim to diagnose these newborns cautiously in accordance with current practice guidelines and protocols.
Key Words: Late onset sepsis, neonate, complete blood count (CBC), procalcitonin (PCT), C-reactive protein (CRP), interleukin 6 (IL-6).
Neonatal sepsis is defined as a systemic condition of bacterial, viral, or fungal origin that can lead to hemodynamic changes and other clinical manifestations that can result in considerable mortality and morbidity (Shane et al., 2017). There are two main categories of neonatal sepsis: early-onset sepsis (EOS) and late-onset sepsis (LOS). EOS is frequently classified as clinical manifestations in the first 72 hours of life, which are acquired before or during delivery and usually represent vertical motherto-infant transmission. LOS is a variable definition, but for the purposes of this article, LOS is defined as infection present after 3 to 7 days of life and related to organisms acquired within the outside environment (Shane et al.,...