Clinical predictors of severe illness in neonates
In a multinational study, researchers evaluated 3177 aged 0-6 days old and 5712 infants aged 7 to 59 days old admitted to healthcare centers in Bangladesh, Bolivia, Ghana, India, Pakistan, and South Africa. They recorded the clinical signs and symptoms and evaluated the “sensitivity, specificity, and odds ratio (OR) for each symptom and sign individually and combined into algorithms to assess their value for predicting severe illness.” Jaundice was excluded in the analysis.
Results showed 12 independent clinical predictors of severe illness that would indicate the need for hospitalization in the 0–6 days age-group. These clinical signs are as follows:
1. History of difficult feeding
2. History of convulsions
3. Movement only when stimulated
4. Fast respiratory rate (≥60)
5. Severe chest indrawing
6. Pyrexia (>37.5 °C)
7. Low body temperature (<35.5)
8. Lethargy
9. Prolonged capillary refill
10. Grunting
11. Cyanosis
12. Stiff limbs
These predictors were also shown to be sensitive in the older age group.
To simply decision-making for primary care practitioners, the number of clinical signs indicative of the need for hospitalization was reduced, taking into account only the first seven in the list. This reduction did not significantly reduce the sensitivity of the check list.
Source:
Clinical signs that predict severe illness in children under age 2 months: a multicentre study. The Young Infants Clinical Signs Study Group. The Lancet 2008; 371:135-142.
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