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

There is a lack of consensus regarding the definition of late-onset bacterial sepsis (LOS) in very preterm infants. 

A recent study thus assessed the concordance of LOS diagnosis between experts in neonatal infection and international classifications and evaluated the potential impact on heart rate variability and rate of “bronchopulmonary dysplasia or death”. 

This retrospective multicenter study included hospitalized infants born before 31 weeks of gestation. An intention to treat with antibiotics was performed for at least 5-days. LOS was either categorized as “certain or probable” or “doubtful” independently by five experts, employing four international classifications. 

The results were as follows-

• 48 infants demonstrated a suspicion for LOS at seven days of life. 
• Following expert classification, 36 were regarded to be “certain or probable”. 
• Following international classification, this number ranged from 13 to 46. 
• Using the expert classification, “bronchopulmonary dysplasia or death” emerged less repeatedly in the doubtful group (25% vs. 78%). 
• Heart rate variability (HRV) changes were found to be different between the two groups. 

Thus, the definition of LOS was not found to be consensual, with a low international and moderate inter-observer agreement. This impacts the assessment of associated organ dysfunction and prognosis.

SOURCE= Bury G, Leroux S, Leon Borrego C, et al. Diagnosis of Neonatal Late-Onset Infection in Very Preterm Infant: Inter-Observer Agreement and International Classifications. Int J Environ Res Public Health. 2021;18(3):882. Published 2021 Jan 20. doi:10.3390/ijerph18030882