Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-24T13:40:46.308Z Has data issue: false hasContentIssue false
  • English
  • Français

A Cost-Outcome Description of the Septic Work-Up for Bacterial Infection in Neonates in a Tertiary Care Hospital

Published online by Cambridge University Press:  10 March 2009

Roger E. Thomas  and
Philip Baker
Roger E. Thomas
Affiliation:
University of Ottawa
Philip Baker
Affiliation:
University of Ottawa
Get access Rights & Permissions [Opens in a new window]

Abstract

Analysis of the septic work-up of 194 neonates at Women's College Hospital, Toronto, showed that the only antepartum condition predicting neonatal sepsis was the mother being on antibiotics. The only postnatal condition predicting sepsis was a maternal postpartum white blood cell count over 11,000. The average cost for tests for a septic work-up in these 194 mother-neonate pairs was $71.48 (Canadian dollars), and the average cost of tests to find a septic case was $1,066.77.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 11 , Issue 1 , Winter 1995 , pp. 11 - 25
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Amato, M., Howald, H., & von Muralt, G.Qualitative changes of white blood cells and perinatal diagnosis of infection in high-risk preterm infants. Paediatrie und Paedologie, 1988, 23, 129–34.Google ScholarPubMed
2.Baertschi, J. & Pfenninger, J.Inzidenz und prognostische Bedeutung positiver Blutkulturen in der neontalen und paediatrischen Intensivmedizin. Schweizerische Medizinische Wochenschrift, 1991, 121, 865–72.Google Scholar
3.Boyer, K. M. & Gotoff, S. P.Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. New England Journal of Medicine, 1986, 314, 1665–69.Google Scholar
4.Burman, L. G.Christensen, P.Christensen, K. et al. Prevention of excess neonatal morbidity associated with group B streptococci by vaginal chlorhexidine disinfection during labour. Lancet, 1992, 340, 65–69.CrossRefGoogle Scholar
5.Chance, G. W.Neonatal intensive care and cost effectiveness. Canadian Medical Association Journal, 1988, 139, 943–46.Google Scholar
6.Christensen, R. D.Brown, M. S.Hall, D. C. et al. Effect on neutrophil kinetics and serum opsonic capacity of intravenous administration of immune globulin to neonates with clinical signs of early-onset sepsis. Journal of Pediatrics, 1991, 4, 606–14.Google Scholar
7.Dillon, H. C. Jr.Khare, S., & Gray, B. M.Group B streptococcal carriage and disease: A 6-year prospective study. Journal of Pediatrics, 1987, 110, 31–36.Google Scholar
8.Dobson, S. R. M., & Baker, C. J.Enterococcal sepsis in neonates: Features by age at onset and occurrence of focal infection. Pediatrics, 1990, 85, 165–71.Google Scholar
9.Dobson, S. R. M.Isaacs, D.Wilkinson, A. R. et al. Reduced use of surface cultures for suspected neonatal sepsis and surveillance. Archives of Disease in Childhood, 1992, 67 (First Special Number), 44–47.CrossRefGoogle ScholarPubMed
10.Evans, M. E.Schaffner, W.Federspiel, C. F. et al. Sensitivity, specificity, and predictive value of body surface cultures in a neonatal intensive care unit. Journal of the American Medical Association, 1988, 259, 248–52.CrossRefGoogle Scholar
11.Fischer, G. W.Weisman, L. E. & Hemming, V. G.Directed immune globulin for the prevention or treatment of neonatal group B streptococcal infections: A review. Clinical Immunology and Immunopathology, 1992, 62, S92–S97.Google Scholar
12.Garland, S. M.Early onset neonatal group B streptococcal (GBS) infection: Associated obstetric risk factors. Australian and New Zealand Journal of Obstetrics and Gynaecology 1991, 31, 117–18.Google Scholar
13.Gerards, L. J.Cats, B. P. & Hoogkamp-Korstanje, J. A.Early neonatal group B streptococcal disease: Degree of colonisation as an important determinant. Journal of Infection, 1985, 11, 119–24.Google Scholar
14.Gerdes, J. S.Clinicopathological approach to the diagnosis of neonatal sepsis. Clinics in Perinatology, 1991, 18, 361–81.CrossRefGoogle Scholar
15.Gerdes, J. S. & Polin, R. A.Sepsis screen in neonates with evaluation of plasma fibronectin. Pediatric Infectious Disease Journal, 1987, 6, 443–46.Google Scholar
16.Gibbs, R. S.Dinsmoor, M. J., Newton, E. R. et al. A randomized trial of intrapartum versus immediate postpartum treatment of women with intra-amniotic infection. Obstetrics and Gynecology, 1988, 72, 823–28.CrossRefGoogle ScholarPubMed
17.Greenspoon, J. S.Wilcox, J. G. & Kirschbaum, T. H.Group B streptococcus: The effectiveness of screening and chemoprophylaxis. Obstetrical and Gynecological Survey, 1991, 46, 499–508.CrossRefGoogle ScholarPubMed
18.Haft, R. F., & Kasper, D. L.Group B streptococcus infection in mother and child. Hospital Practice, 1991, 26(12), 111–22, 125–28, 133–34.CrossRefGoogle ScholarPubMed
19.Hamoudi, A. C.Marcon, M. J., Cannon, H. J. et al. Comparison of three major antigen detection methods for the diagnosis of Group B streptococcal sepsis in neonates. Pediatric Infectious Disease, 1983, 2, 432–35.CrossRefGoogle Scholar
20.Hueston, W. J.Preventing group B streptococcal infection in newborns. American Family Physician, 1991, 43, 487–92.Google ScholarPubMed
21.Kite, P.Millar, M. R.Gorham, P. et al. Comparison of five tests used in diagnosis of neonatal bacteraemia. Archives of Disease in Childhood, 1988, 63, 639–43.CrossRefGoogle ScholarPubMed
22.Knudsen, F. U. & Steinrud, J.Septicaemia of the newborn, associated with ruptured foetal membranes, discoloured amniotic fluid or maternal fever. Acta Paediatrica Scandinavica, 1976, 65, 725–31.CrossRefGoogle ScholarPubMed
23.Lannering, B., Larsson, L. E., Rojas, J., et al. Early onset group B streptococcal disease: Seven year experience and clinical scoring system. Acta Paediatrica Scandinavica, 1983, 72, 597–602.CrossRefGoogle Scholar
24.Lau, Y. L., & Hey, E.Sensitivity and specificity of daily tracheal aspirate cultures in predicting organisms causing bacteremia in ventilated neonates. Pediatric Infectious Disease Journal, 1991, 10, 290–94.Google Scholar
25.Manroe, B. L., Weinberg, A. G., Rosenfeld, C. R., et al. The neonatal blood count in health and disease: I. Reference values for neutrophilic cells. Journal of Pediatrics, 1979, 95, 89–98.Google Scholar
26.Matorras, R., Garcia-Perea, A., Omenaca, F., et al. Intrapartum chemoprophylaxis of early-onset group B streptococcal disease. European Journal of Obstetrics and Gynecology and Reproductive Biology, 1991, 40, 57–62.CrossRefGoogle ScholarPubMed
27.Mifsud, A., Seal, D., Wall, R., et al. Reduced neonatal mortality from infection after introduction of respiratory monitoring. British Medical Journal, 1988, 296 (January 2), 17–18.CrossRefGoogle ScholarPubMed
28.Noya, F. J. D., & Baker, C. J.Prevention of group B streptococcal infection. Infectious Disease Clinics of North America, 1992, 6, 41–55.Google Scholar
29.Ohlsson, A., Shennan, A. T., & Rose, T. H.Review of causes of perinatal mortality in a regional perinatal center, 1980 to 1984. American Journal of Obstetrics and Gynecology, 1987, 157, 443–45.Google Scholar
30.Ohlsson, A., & Vearncombe, M.Congenital and nosocomial sepsis in infants born in a regional perinatal unit: Cause, outcome, and white blood cell response. American Journal of Obstetrics and Gynecology, 1987, 156, 407–13.Google Scholar
31.Ontario Ministry of Health. Schedule of benefits. 10 1, 1992.Google Scholar
32.Opal, S. M., Cross, A., Palmer, M., et al. Group B streptococcal sepsis in adults and infants. Archives of Internal Medicine, 1988, 148, 641–46.Google Scholar
33.Philip, A. G. S.Decreased use of antibiotics using a neonatal sepsis screening technique. Journal of Pediatrics, 1981, 98, 795–99.Google Scholar
34.Pierce, J. R., Merenstein, G. B., & Stocker, J. T.Immediate postmortem cultures in an intensive care nursery. Pediatric Infectious Disease Journal, 1984, 3, 510–13.Google Scholar
35.Pyati, S. P., Pildes, R. S., Jacobs, N. M., et al. Penicillin in infants weighing two kilograms or less with early-onset Group B streptococcal disease. New England Journal of Medicine, 1983, 308, 1383–89.CrossRefGoogle ScholarPubMed
36.Rodwell, R. L., Leslie, A. L., & Tudehope, D. I.Early diagnosis of neonatal sepsis using a hematologic scoring system. Journal of Pediatrics, 1988, 112, 761–67.CrossRefGoogle ScholarPubMed
37.Rozycki, H. J., Stahl, G. E., & Baumgart, S.Impaired sensitivity of a single early leukocyte count in screening for neonatal sepsis. Pediatric Infectious Disease Journal, 1987, 6, 440–42.CrossRefGoogle ScholarPubMed
38.Sabel, K.-G., & Wadsworth, Ch.C-reactive protein (CRP) in early diagnosis of neonatal septicemia. Acta Paediatrica Scandinavica, 1979, 68, 825–31.CrossRefGoogle ScholarPubMed
39.Sarff, L. D., Platt, L. D., & McCracken, G. H.Cerebrospinal fluid evaluation in neonates: Comparison of high risk neonates with and without meningitis. Journal of Pediatrics, 1976, 88, 473–77.Google Scholar
40.Schuchat, A., Oxtoby, M., Cochi, S., et al. Population-based risk factors for neonatal group B streptococcal disease: Results of a cohort study in metropolitan Atlanta. Journal of Infectious Diseases, 1990, 162, 672–677.CrossRefGoogle Scholar
41.Shattuck, K. E., & Chonmaitree, T.The changing spectrum of neonatal meningitis over a fifteen-year period. Clinical Pediatrics, 1992, 31, 130–36.Google Scholar
42.Sherman, M. P., Chance, K. H., & Goetzman, B. W.Gram's stains of tracheal secretions predict neonatal bacteremia. American Journal of Diseases of Children, 1984, 138, 848–50.Google ScholarPubMed
43.Sherman, M. P., Goetzman, B. W., Ahlfors, C. E., et al. Tracheal aspiration and its clinical correlates in the diagnosis of congenital pneumonia. Pediatrics, 1980, 65, 258–68.Google Scholar
44.Simon, C., Schroeder, H., Beyer, C., et al. Neonatal sepsis in an intensive care unit and results of treatment. Infection (Munich), 1991, 26(3), 146–48.Google Scholar
45.Squire, E., Favara, B., & Todd, J.Diagnosis of neonatal bacterial infection: Hematologic and pathologic findings in fatal and nonfatal cases. Pediatrics, 1979, 64, 60–64.CrossRefGoogle ScholarPubMed
46.St. Geme, J. W. Jr., Murray, D. L., Carter, J., et al. Perinatal bacterial infection after prolonged rupture of amniotic membranes: An analysis of risk and management. Journal of Pediatrics, 1984, 104, 608–13.CrossRefGoogle ScholarPubMed
47.St. Geme, J. W., Ill, Bell, L. M., Baumgart, S., et al. Distinguishing sepsis from blood culture contamination in young infants with blood cultures growing coagulase-negative staphylococci. Pediatrics, 1990, 86, 157–62.Google Scholar
48.Stahlman, M. T.Newborn intensive care: Success or failure? Journal of Pediatrics, 1984, 105, 162–67.CrossRefGoogle ScholarPubMed
49.Toellner, U.Early diagnosis of septicemia in the newborn: Clinical studies and sepsis score. European Journal of Pediatrics, 1982, 138, 331–37.Google Scholar
50.Tuppurainen, N., & Hallman, M.Prevention of neonatal group B streptococcal disease: Intrapartum detection and chemoprophylaxis of heavily colonized parturients. Obstetrics and Gynecology, 1989, 73, 583–87.Google Scholar
51.Visser, V. E., & Hall, R. T.Lumbar puncture in the evaluation of suspected neonatal sepsis. Journal of Pediatrics, 1980, 96, 1063–67.CrossRefGoogle ScholarPubMed
52.Voora, S., Srinivasan, G., Lilien, L. D., et al. Fever in full-term newborns in the first four days of life. Pediatrics, 1982, 69, 40–44.Google Scholar
53.Wilkins, E. G., & Roberts, C.Screening for enteropathogenic Escherichia coli. Journal of Hospital Infection, 1988, 12, 177–82.Google Scholar
54.Wiswell, T. E., & Hachey, W. E.Multiple site blood cultures in the initial evaluation for neonatal sepsis during the first week of life. Pediatric Infectious Disease Journal, 1991, 10, 365–69.CrossRefGoogle ScholarPubMed
55.Yagupsky, P., Menegus, M. A., & Powell, K. R.The changing spectrum of group B streptococcal disease in infants: An eleven-year experience in a tertiary care hospital. Pediatric Infectious Disease Journal, 1991, 10, 801–8.CrossRefGoogle Scholar