Predicting “Sepsis Ruled In” in Very Low Birth Weight NICU patients: A 3-NICU collaboration

Background: Signs of late-onset septicemia (LOS) and necrotizing enterocolitis (NEC) overlap with normal variations in preterm neonatal physiology, and about 10-20 sepsis evaluations are performed and antibiotics given for each case of proven LOS or NEC. Early diagnosis is important for improving outcomes, but unnecessary antibiotics increase multiple morbidities. Objective: To develop a model for accurate prediction of LOS or NEC using clinical variables and signs at the time of LOS/NEC evaluation. Methods: Records of consecutive very low birth weight (VLBW) infant admissions at 3 NICUs were reviewed, excluding those that died within 3 days of birth or were admitted after 28d. For infants with F0B31 blood culture for suspected LOS/NEC, the first positive workup was evaluated and if all workups were negative, the first negative was evaluated. A positive LOS/NEC evaluation was defined as a positive blood culture or radiographic diagnosis of NEC and F0B3 5d of antibiotics given, and sepsis ruled out (SRO) was …