Clinical-Biological Score of Labenne et al for Diagnosing Early-Onset Neonatal Infection (EONI) in a Preterm Infant

 

Patient selection: preterm infant in the neonatal intensive care unit (NICU)

 

Parameters:

(1) premature rupture of the membranes (PROM) prior to delivery

(2) prenatal maternal colonization (typically with Group B Streptococcus = GBS)

(3) mechanical ventilation required at birth

(4) blood IL-8 concentration in pg/mL

(5) blood IL-6 concentration in pg/mL

(6) blood C-reactive protein (CRP) in mg/L

Parameter	Finding	Points
PROM	none or <= 12 hours	0
	> 12 hours	1
prenatal maternal colonization	absent	0
	present	1
mechanical ventilation required	no	0
	yes	2
IL-8 concentration	< 200 pg/mL	0
	>= 200 pg/mL	2.5
IL-6 concentration	< 300 pg/mL	0
	>= 300 pg/mL	3.5
CRP	< 10 mg/L	0
	>= 10 mg/L	3

 

where:

• Prenatal maternal colonization was indicated by a positive vaginal or urine culture result available at delivery.

• The reference range for the biomarker assays was not given. Testing was done with the CBA human inflammation kit by BD Biosciences. The lower limit of detection for the interleukins was 2.5 pg/mL for IL-6 and 3.6 pg/mL for IL-8.

 

clinical score =

= (points for PROM) + (points for maternal colonization) + (points for mechanical ventilation)

 

clinical and one biomarker score =

= (clinical score) + (points for 1 of the 3 biomarkers)

 

clinical and two interleukin marker score =

= (clinical score) + (points for IL-8) + (points for IL-6)

 

Interpretation:

• minimum scores: 0

• maximum clinical score: 4

• maximum clinical plus one biomarker score: 7.5

• maximum clinical plus 2 IL markers: 10

• The higher the score the more likely sepsis was present.

• A clinical score >= 3 had the best performance.

• A clinical score plus one biomarker >= 5 had the best performance.

• A clinical score plus 2 IL biomarkers >= 6.5 had the best performance.

 

Performance:

• The clinical plus 2 IL markers score had the best AUC at 96%.