자료유형  

 학위논문

Control Number  

0016933739

International Standard Book Number  

9798380260350

Dewey Decimal Classification Number  

616

Main Entry-Personal Name  

Rick, Anne-Marie.

Publication, Distribution, etc. (Imprint  

[S.l.] : University of Pittsburgh., 2021

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2021

Physical Description  

1 online resource(104 p.)

General Note  

Source: Dissertations Abstracts International, Volume: 85-03, Section: B.

General Note  

Advisor: Hooven, Thomas;Shaikh, Nader;Williams, John;Switzer, Galen;Martin, Judith.

Dissertation Note  

Thesis (Ph.D.)--University of Pittsburgh, 2021.

Restrictions on Access Note  

This item must not be sold to any third party vendors.

Summary, Etc.  

요약Early onset sepsis (EOS) occurs infrequently in newborns but can result in life-long deficits or even death. There is tremendous uncertainty about how to best identify infected infants. We aimed to validate the new obstetric diagnoses for intraamniotic infection, collectively known as Triple I, for their ability to identify EOS among infants ≥ 35 weeks gestational age and compare it to other approaches. We first determined that the obstetric diagnosis, suspected intraamniotic infection, modestly improves identification of infants with EOS compared to clinical chorioamnionitis with a numerically higher sensitivity and significantly higher area under the receiver operating curve (AUC). This solidifies use of this diagnosis in obstetric and pediatric practice over previous criteria. However, its test characteristics were suboptimal with a sensitivity of only 53% (95%CI: 40-66) and an AUC of 0.752 (95%CI: 0.682-0.821). Next, we combined diagnosis of suspected intraamniotic infection with the infant's clinical appearance after birth and assessed test characteristics of this categorical approach for EOS and compared it to the multivariate EOS risk calculator, an alternative, evidence-based approach to EOS screening. We identified that the categorical approach had sensitivity of 90% (95%CI: 79-96%) and AUC of 0.875 (0.825-0.924). While this approach identified EOS better than the calculator, the calculator maintained higher specificity. We then evaluated if placenta data can enhance specificity of the categorical approach. Among infants ≥ 35 weeks gestational age exposed to suspected intraamniotic infection in utero, we identified that combining absence of umbilical cord inflammation and placenta culture growth could successfully rule-out 90% of non-infected but exposed infants. However, the maximum benefit of incorporating placenta data occurs if it is obtained shortly after delivery, a practice that is not commonly done. In conclusion, we successfully validated that a categorical approach combining diagnosis of maternal suspected intraamniotic infection and infant clinical appearance will identify the majority of EOS cases. However, it lacks specificity. While this can be improved using placenta histopathology and culture, it would require significant practice change. As institutions re-consider their approach to EOS screening given recent guideline changes, it is necessary to evaluate the strengths and limitations of each approach.

Subject Added Entry-Topical Term  

Childrens health.

Subject Added Entry-Topical Term  

Clinical medicine.

Subject Added Entry-Topical Term  

Childbirth & labor.

Subject Added Entry-Topical Term  

Sepsis.

Subject Added Entry-Topical Term  

Bacteria.

Subject Added Entry-Topical Term  

Fever.

Subject Added Entry-Topical Term  

Pathology.

Subject Added Entry-Topical Term  

Births.

Subject Added Entry-Topical Term  

Blood.

Subject Added Entry-Topical Term  

Mothers.

Subject Added Entry-Topical Term  

Pediatrics.

Subject Added Entry-Topical Term  

Cardiac arrhythmia.

Subject Added Entry-Topical Term  

Antibiotics.

Subject Added Entry-Topical Term  

Obstetrics.

Subject Added Entry-Topical Term  

Bacterial infections.

Subject Added Entry-Topical Term  

Newborn babies.

Subject Added Entry-Topical Term  

Breastfeeding & lactation.

Subject Added Entry-Topical Term  

Birth weight.

Subject Added Entry-Topical Term  

Babies.

Subject Added Entry-Topical Term  

Heart rate.

Subject Added Entry-Topical Term  

Medicine.

Subject Added Entry-Topical Term  

Pharmaceutical sciences.

Subject Added Entry-Topical Term  

Physiology.

Added Entry-Corporate Name  

University of Pittsburgh.

Host Item Entry  

Dissertations Abstracts International. 85-03B.

Host Item Entry  

Dissertation Abstract International

Electronic Location and Access  

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Control Number  

joongbu:641386