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20031107-10# Beyond the complete blood
cell count and c-reactive protein - Archives
of Pediatrics and Adolescent Medicine , vol 157, no 6, June
2003, pp 511-516 Malik A; Hui CPS; Pennie RA; et al - (June
2003) |
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OBJECTIVE: To systematically review the accuracy of
modern laboratory tests for the diagnosis of serious bacterial infection
in newborns. METHODS: The MEDLINE, EMBASE, and Cochrane Library databases
were searched using the keywords newborn, infection, sepsis, and
diagnosis. We included studies published from 1995 through 2001 that
included infants younger than 90 days with proven bacterial growth in a
sample from a sterile site. Whenever possible, relevant data were
extracted to calculate likelihood ratios (LRs) for whether each test can
diagnose a serious bacterial infection. Two independent reviewers selected
and reviewed the articles (interobserver agreement, kappa = 0.80). All
disagreements were resolved by consensus. RESULTS: Of the 137 citations we
retrieved, 37 articles met the inclusion criteria; 17 studies, evaluating
11 different tests, met the highest methodological criteria. The most
commonly evaluated test was interleukin 6 (IL-6) level (n = 7 studies).
The remaining tests were each evaluated in no more than 3 studies.
Positive LRs ranged from 1.5 to infinity. Six individual tests examined in
8 studies had LRs of more than 10 (range, 12.5- infinity ). Combined tests
also had a wide range of LRs (3.4-9.9). All studies were performed in
single medical centers and had small sample sizes, making recommendations
according to gestational age criteria difficult. CONCLUSIONS: We found few
methodologically rigorous studies of the accuracy of laboratory tests for
the diagnosis of bacterial infection in newborns; in a significant
proportion of studies, the accuracy of the tests could not be
independently determined because of a lack of adequate data. There was
marked heterogeneity in sample selection and cutoff levels for diagnosis
of neonatal sepsis. A few tests showed promising accuracy, but there are
insufficient data to support their confident use as clinical tools. (33
references) (Author) |
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