Can we improve early identification of neonatal late-onset sepsis? A validated prediction model

Objective: No single test can accurately identify neonatal late-onset sepsis (LOS). Our aim was to use clinical evaluation with laboratory tests to rapidly assess sepsis risk. Study design: A retrospective case-control study was performed in a tertiary Neonatal Center during the years 2016–2019. Infants with bacteriologically confirmed LOS were compared with control infants. A clinical health evaluation score was assigned to each infant. A prediction model was developed and validated by multivariable analysis. Results: The study included 145 infants, 48 with sepsis, and 97 controls. LOS was independently associated with: sick appearance (OR: 5.7, 95% CI: 1.1–29.1), C-reactive protein > 0.75 (OR: 5.4, 95% CI: 1.1–26.3), and neutrophil-to-lymphocyte ratio > 1.5 (OR: 6.7, 95% CI: 1.2–38.5). Our model had an area under the receiver operating characteristic curve of 0.92 (95% CI: 0.86–0.97). Conclusions: Clinical evaluation with neutrophil-to-lymphocyte ratio and C-reactive protein can rapidly identify LOS enabling decreased health costs and antibiotic use.