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Diagnosis of Neonatal Sepsis: A Clinical and Laboratory Challenge

¹ National Research Council, Rome, Italy
Departments of² Pediatrics, and ³ Public Health Science, "La Sapienza", University of Rome, Rome, Italy

^aAddress correspondence to this author at: Department of Pediatrics, "La Sapienza", University of Rome, Viale R. Elena 324, 00161 Rome, Italy. Fax 39-06-4997-9215; e-mail Claudio.Chiesa@Uniroma1.it.

The first 300 words of the full text of this article appear below.

	Introduction

 
The evaluation of tests for neonatal sepsis is important because the infection may present a very serious threat to the baby. There is an urgent need to know whether the baby has sepsis to institute treatment as quickly as possible. Confirmation of the diagnosis may take time, and diagnostic tests are used to obtain a rapid indication of the infection status. These tests are not perfect. Some real cases of infection will produce negative test results, whereas some babies without infection will test positive. The potential usefulness of the test will depend, above all, on the clinical condition of the baby. If the baby is really very sick, the test will not give very much additional information. Similarly, if the baby is evidently well, a clinical examination will be sufficient and a positive test result would not dramatically increase the probability that the baby is infected. It is in situations in which the clinical picture leaves the physician in doubt about the infection status that a diagnostic test is likely to be most useful. Thus, the result of a diagnostic test must be evaluated in the light of the clinical condition of the baby.

Extensive literature exists on single laboratory tests or combinations of tests, as well as tests used together with risk factors and/or clinical signs, to diagnose neonatal sepsis. In many instances, the results of the evaluations have been conflicting. There are several possible explanations for the divergent results, and the purpose of this review is to update readers on the topic and raise issues that should be addressed in the future.

	Basic Physiology of Neonatal Infection

 
Throughout pregnancy and until the membranes rupture, the fetus is relatively protected from the microbial flora of the mother by the chorioamniotic membranes, the placenta, and poorly understood antibacterial factors in amniotic fluid (1). . . . [Full Text of this Article]

	Perinatally vs Postnatally Acquired Infections

 

	Systemic Response to Infection in Newborns

 

	Illness Severity in Newborns

 

	Laboratory Tests

 
normal standard: general considerations
normal (and abnormal) ranges in the newborn infant
role of new markers
effect of illness severity and risk status on markers

	Methodologic Issues

 
general considerations
accuracy of laboratory methods

The following articles in journals at HighWire Press have cited this article:

				L. Pacifico, A. Panero, P. Colarizi, M. Matrunola, A. F. Simonetti, and C. Chiesa Neonatal Candida albicans Septic Thrombosis of the Portal Vein followed by Cavernous Transformation of the Vessel J. Clin. Microbiol., September 1, 2004; 42(9): 4379 - 4382. [Abstract] [Full Text] [PDF]