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Overview :
Griffin et al developed a clinical score for predicting
neonatal sepsis. The authors are from the University of Virginia, Wake Forest
University and MedImmune Corporation.
Patient selection: neonate
Parameters:
(1) lethargy or hypotonia
(2) temperature instability
(3) plasma or serum glucose
(4) white blood cell count
(5) ratio of immature to mature neutrophils (decimal fraction
bands)
(6) feeding intolerance
(7) respiratory status
|
Parameter |
Finding |
Points |
|
lethargy or hypotonia |
absent |
0 |
|
|
present |
1 |
|
temperature instability |
absent |
0 |
|
|
present |
1 |
|
plasma or serum glucose |
<= 180 mg/dL |
0 |
|
|
> 180 mg/dL (hyperglycemia) |
1 |
|
white blood cell count |
< 5,000 per µL |
1 |
|
|
5,000 - 25,000 per µL |
0 |
|
|
> 25,000 per µL |
1 |
|
ratio of immature to total neutrophils |
<= 0.2 |
0 |
|
|
> 0.2 |
2 |
|
feeding intolerance |
absent |
0 |
|
|
present |
2 |
|
respiratory status |
normal |
0 |
|
|
need for ventilatory support with increase in FIO2 25%
from baseline |
1 |
|
|
50% or greater increase in apneic episodes over a 24
hour period after being extubated and stable for 3 days |
2 |
|
|
severe apnea requiring positive pressure
ventilation |
2 |
where:
• The
scoring for respiratory status assumes that only 1 of the conditions will be
met.
• Feeding
intolerance involves holding a feeding for > 24 hours in an infant who has
been tolerating advancing or full feeds for 3 days.
•
Temperature instability involves 2
or more episdoes of abnormal temperature (< 36.2°C or > 38°C) within an 8
hour period.
• Severe
hypotension is a sign of sepsis but was infrequent in the study population so
was not included in the score.
•
Thrombocytopenia with new onset did not reach a sufficient association to
warrant inclusion.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• A score >= 2 was associated with sepsis.
Performance:
• Up to 40%
of neonates with proven sepsis had a clinical score of 0 (page 226). This is
because some criteria have high thresholds and/or require monitoring for 18+
hours.
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