Neonatal sepsis prediction through clinical decision support algorithms: A systematic review

Emma Persad; Kerstin Jost; Antoine Honoré; David Forsberg; Karen Coste; Hanna Olsson; Susanne Rautiainen; Eric Herlenius

doi:10.1111/apa.16083

Neonatal sepsis prediction through clinical decision support algorithms: A systematic review

Emma Persad, Kerstin Jost, Antoine Honoré, David Forsberg, Karen Coste, Hanna Olsson, Susanne Rautiainen, Eric Herlenius

Research output: Journal article (peer-reviewed) › Review article

26 Citations (Scopus)

Abstract

AIM: To systematically summarise the current evidence of employing clinical decision support algorithms (CDSAs) using non-invasive parameters for sepsis prediction in neonates.

METHODS: A comprehensive search in PubMed, CENTRAL and EMBASE was conducted. Screening, data extraction and risk of bias were performed by two authors. The certainty of the evidence was assessed using GRADE.

PROSPERO ID: CRD42020205143.

RESULTS: After abstract and full-text screening, 36 studies comprising 18,096 infants were included. Most CDSAs evaluated heart rate (HR)-based parameters. Two publications derived from one randomised-controlled trial assessing HR characteristics reported significant reduction in 30-day septicaemia-related mortality. Thirty-four non-randomised studies found promising yet inconclusive results.

CONCLUSION: Heart rate-based parameters are reliable components of CDSAs for sepsis prediction, particularly in combination with additional vital signs and demographics. However, inconclusive evidence and limited standardisation restricts clinical implementation of CDSAs outside of a controlled research environment. Further experimentation and comparison of parameter combinations and testing of new CDSAs are warranted.

Original language	English
Pages (from-to)	3201-3226
Number of pages	26
Journal	Acta Paediatrica, International Journal of Paediatrics
Volume	110
Issue number	12
DOIs	https://doi.org/10.1111/apa.16083
Publication status	Published - Dec 2021

Keywords

Algorithms
Bias
Decision Support Systems, Clinical
Humans
Infant
Infant, Newborn
Neonatal Sepsis/diagnosis
Sepsis/diagnosis

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10.1111/apa.16083

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title = "Neonatal sepsis prediction through clinical decision support algorithms: A systematic review",

abstract = "AIM: To systematically summarise the current evidence of employing clinical decision support algorithms (CDSAs) using non-invasive parameters for sepsis prediction in neonates.METHODS: A comprehensive search in PubMed, CENTRAL and EMBASE was conducted. Screening, data extraction and risk of bias were performed by two authors. The certainty of the evidence was assessed using GRADE.PROSPERO ID: CRD42020205143.RESULTS: After abstract and full-text screening, 36 studies comprising 18,096 infants were included. Most CDSAs evaluated heart rate (HR)-based parameters. Two publications derived from one randomised-controlled trial assessing HR characteristics reported significant reduction in 30-day septicaemia-related mortality. Thirty-four non-randomised studies found promising yet inconclusive results.CONCLUSION: Heart rate-based parameters are reliable components of CDSAs for sepsis prediction, particularly in combination with additional vital signs and demographics. However, inconclusive evidence and limited standardisation restricts clinical implementation of CDSAs outside of a controlled research environment. Further experimentation and comparison of parameter combinations and testing of new CDSAs are warranted.",

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author = "Emma Persad and Kerstin Jost and Antoine Honor{\'e} and David Forsberg and Karen Coste and Hanna Olsson and Susanne Rautiainen and Eric Herlenius",

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year = "2021",

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T2 - A systematic review

AU - Persad, Emma

AU - Jost, Kerstin

AU - Honoré, Antoine

AU - Forsberg, David

AU - Coste, Karen

AU - Olsson, Hanna

AU - Rautiainen, Susanne

AU - Herlenius, Eric

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N2 - AIM: To systematically summarise the current evidence of employing clinical decision support algorithms (CDSAs) using non-invasive parameters for sepsis prediction in neonates.METHODS: A comprehensive search in PubMed, CENTRAL and EMBASE was conducted. Screening, data extraction and risk of bias were performed by two authors. The certainty of the evidence was assessed using GRADE.PROSPERO ID: CRD42020205143.RESULTS: After abstract and full-text screening, 36 studies comprising 18,096 infants were included. Most CDSAs evaluated heart rate (HR)-based parameters. Two publications derived from one randomised-controlled trial assessing HR characteristics reported significant reduction in 30-day septicaemia-related mortality. Thirty-four non-randomised studies found promising yet inconclusive results.CONCLUSION: Heart rate-based parameters are reliable components of CDSAs for sepsis prediction, particularly in combination with additional vital signs and demographics. However, inconclusive evidence and limited standardisation restricts clinical implementation of CDSAs outside of a controlled research environment. Further experimentation and comparison of parameter combinations and testing of new CDSAs are warranted.

AB - AIM: To systematically summarise the current evidence of employing clinical decision support algorithms (CDSAs) using non-invasive parameters for sepsis prediction in neonates.METHODS: A comprehensive search in PubMed, CENTRAL and EMBASE was conducted. Screening, data extraction and risk of bias were performed by two authors. The certainty of the evidence was assessed using GRADE.PROSPERO ID: CRD42020205143.RESULTS: After abstract and full-text screening, 36 studies comprising 18,096 infants were included. Most CDSAs evaluated heart rate (HR)-based parameters. Two publications derived from one randomised-controlled trial assessing HR characteristics reported significant reduction in 30-day septicaemia-related mortality. Thirty-four non-randomised studies found promising yet inconclusive results.CONCLUSION: Heart rate-based parameters are reliable components of CDSAs for sepsis prediction, particularly in combination with additional vital signs and demographics. However, inconclusive evidence and limited standardisation restricts clinical implementation of CDSAs outside of a controlled research environment. Further experimentation and comparison of parameter combinations and testing of new CDSAs are warranted.

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Neonatal sepsis prediction through clinical decision support algorithms: A systematic review

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