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World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study

Author

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  • Omolabake Akinseye
  • Constantin R Popescu
  • Msandeni Chiume-Kayuni
  • Michael A Irvine
  • Norman Lufesi
  • Tisungane Mvalo
  • Niranjan Kissoon
  • Matthew O Wiens
  • Pascal M Lavoie

Abstract

Bacterial sepsis is generally a major concern in ill infants. To help triaging decisions by front-line health workers in these situations, the World Health Organization (WHO) has developed danger signs (DS). The objective of this study was to evaluate the extent to which nine DS predict bacterial sepsis in young infants presenting with suspected sepsis in a low-income country setting. The study pragmatically evaluated nine DS in infants younger than 3 months with suspected sepsis in a regional hospital in Lilongwe, Malawi, between June 2018 and April 2020. Main outcomes were positive blood or cerebrospinal fluid (CSF) cultures for neonatal pathogens, and mortality. Among 401 infants (gestational age [mean ± SD]: 37.1±3.3 weeks, birth weight 2865±785 grams), 41 had positive blood or CSF cultures for a neonatal pathogen. In-hospital mortality occurred in 9.7% of infants overall (N = 39/401), of which 61.5% (24/39) occurred within 48 hours of admission. Mortality was higher in infants with bacterial sepsis compared to other infants (22.0% [9/41] versus 8.3% [30/360]; p = 0.005). All DS were associated with mortality except for temperature instability and tachypnea, whereas none of the DS were significantly associated with bacterial sepsis, except for “unable to feed” (OR 2.25; 95%CI: 1.17–4.44; p = 0.017). The number of DS predicted mortality (OR: 1.75; 95%CI: 1.43–2.17; p

Suggested Citation

  • Omolabake Akinseye & Constantin R Popescu & Msandeni Chiume-Kayuni & Michael A Irvine & Norman Lufesi & Tisungane Mvalo & Niranjan Kissoon & Matthew O Wiens & Pascal M Lavoie, 2023. "World Health Organization Danger Signs to predict bacterial sepsis in young infants: A pragmatic cohort study," PLOS Global Public Health, Public Library of Science, vol. 3(11), pages 1-12, November.
    • Handle: RePEc:plo:pgph00:0001990
    DOI: 10.1371/journal.pgph.0001990
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    1. Bich-Tram Huynh & Elsa Kermorvant-Duchemin & Rattanak Chheang & Frederique Randrianirina & Abdoulaye Seck & Elisoa Hariniaina Ratsima & Zafitsara Zo Andrianirina & Jean-Baptiste Diouf & Armya Youssouf, 2021. "Severe bacterial neonatal infections in Madagascar, Senegal, and Cambodia: A multicentric community-based cohort study," PLOS Medicine, Public Library of Science, vol. 18(9), pages 1-19, September.
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