Neonatal Sepsis: Likelihood Ratios

Introduction: 90% of neonatal sepsis occurs within 24 hours of delivery. Mostly from group B Streptococcus. If there is suspicion of neonatal sepsis, infants should get blood cx, LP, and CBC, CRP, etc.

If mom has risk factors, then mom should be given ampicillin 1g at least 4 hours prior to delivery. Infants at risk should be monitored for at least 48 hours.

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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Live Births	0.08%	Adv Neonatal Care. 2003 Feb;3(1):3-13. PMID: 12882177
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The likelihood ratios of findings for Neonatal Sepsis are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Negative Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Elevated I/T Ratio	+ 0 -	1.6	0.5
immature / total polys Study: Mymensingh Med J. 2009 Jan;18(1):56-61. PMID: 19182751

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Elevated CRP	+ 0 -	3.5	0.7
initial, for early-onset sepsis Study: Adv Neonatal Care. 2003 Feb;3(1):3-13. PMID: 12882177

Poorly Diagnostic Findings
Finding	Result	+LR	-LR
[ + ] Elevated ESR	+ 0 -	1.6	0.6
"micro-ESR" Study: Mymensingh Med J. 2009 Jan;18(1):56-61. PMID: 19182751

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Serial CRP	+ 0 -	44.5	0.1
8 hours apart. For early-onset sepsis Study: Adv Neonatal Care. 2003 Feb;3(1):3-13. PMID: 12882177
[ + ] Serial CRP and IL-8	+ 0 -	4.7	0.1
both elevated Study: Adv Neonatal Care. 2003 Feb;3(1):3-13. PMID: 12882177
[ + ] Serial CRP	+ 0 -	3.4	0.1
8 hours apart. For late-onset sepsis. Study: Adv Neonatal Care. 2003 Feb;3(1):3-13. PMID: 12882177
[ + ] Elevated CRP	+ 0 -	7.8	0.4
inital CRP, for late-onset sepsis Study: Adv Neonatal Care. 2003 Feb;3(1):3-13. PMID: 12882177