Diagnosis of Neonatal Late-Onset Infection in Very Preterm Infant: Inter-Observer Agreement and International Classifications

Gaelle Bury, Stéphanie Leroux, Cristhyne Leon Borrego, Christèle Gras Leguen, Delphine Mitanchez, Geraldine Gascoin, Aurore Thollot, Jean Michel Roué, Guy Carrault, Patrick Pladys and Alain Beuchée
Additional contact information
Gaelle Bury: Department of Neonatology, CHU Rennes, Rennes University, Inserm-CIC 1414, F-35033 Rennes, France
Stéphanie Leroux: Department of Neonatology, CHU Rennes, Rennes University, Inserm-CIC 1414, F-35033 Rennes, France
Cristhyne Leon Borrego: LTSI-UMR_S Inserm 1099, University of Rennes, F-35000 Rennes, France
Christèle Gras Leguen: Department of Neonatology, University Hospital of Nantes, F-44000 Nantes, France
Delphine Mitanchez: Department of Neonatology, University Hospital of Tours, F-37044 Tours, France
Geraldine Gascoin: Department of Neonatology, University Hospital of Angers, F-49100 Angers, France
Aurore Thollot: Department of Neonatology, University Hospital of Poitiers, F-86021 Poitiers, France
Jean Michel Roué: Department of Neonatology, University Hospital of Brest, F-29200 Brest, France
Guy Carrault: LTSI-UMR_S Inserm 1099, University of Rennes, F-35000 Rennes, France
Patrick Pladys: Department of Neonatology, CHU Rennes, Rennes University, Inserm-CIC 1414, F-35033 Rennes, France
Alain Beuchée: Department of Neonatology, CHU Rennes, Rennes University, Inserm-CIC 1414, F-35033 Rennes, France

IJERPH, 2021, vol. 18, issue 3, 1-15

Abstract: Background: The definition of late-onset bacterial sepsis (LOS) in very preterm infants is not unified. The objective was to assess the concordance of LOS diagnosis between experts in neonatal infection and international classifications and to evaluate the potential impact on heart rate variability and rate of “bronchopulmonary dysplasia or death”. Methods: A retrospective (2017–2020) multicenter study including hospitalized infants born before 31 weeks of gestation with intention to treat at least 5-days with antibiotics was performed. LOS was classified as “certain or probable” or “doubtful” independently by five experts and according to four international classifications with concordance assessed by Fleiss’s kappa test. Results: LOS was suspected at seven days (IQR: 5–11) of life in 48 infants. Following expert classification, 36 of them (75%) were considered as “certain or probable” (kappa = 0.41). Following international classification, this number varied from 13 to 46 (kappa = −0.08). Using the expert classification, “bronchopulmonary dysplasia or death” occurred less frequently in the doubtful group (25% vs. 78%, p < 0.001). Differences existed in HRV changes between the two groups. Conclusion: The definition of LOS is not consensual with a low international and moderate inter-observer agreement. This affects the evaluation of associated organ dysfunction and prognosis.

Keywords: neonate; sepsis; infection; heart rate variability; bronchopulmonary dysplasia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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