Singh et al evaluated a number of clinical signs and symptoms for their ability to identify a neonate with late onset sepsis. These can help to evaluate a neonate who is being seen in a hospital setting in a developing country. The authors are from the Postgraduate Institute of Medical Education and Research in Chandigarh, India.


Initial number of clinical signs and symptoms: 16

Final number: 7


Patient selection: Infants with major congenital malformations were excluded. Onset of symptoms was from 73 hours to 28 days after birth.


Definite sepsis was defined as bacteria isolated from blood or CSF.

Probable sepsis was either chest X-ray consistent with pneumonia or 2 positive sepsis screen parameters.


Clinical signs and symptoms scored 2 points if present:

(1) grunting (audible sound on expiration)

(2) abdominal distention (increase in abdominal girth by 2 cm)


Clinical signs and symptoms scored 1 point if present:

(3) lethargy (persistent difficulty in arousing not explained by sedative therapy)

(4) increased pre-feeding aspirate (> 20% of the feed volume aspirated before a feed at least twice within a 24 hour period)

(5) tachycardia (heart rate > 160 beats per minute >= 2 occasions >= 1 hour apart within 24 hours)

(6) hyperthermia (axillary temperatures > 37.5°C on >= 2 occasions >= 1 hour apart within 24 hours)

(7) chest retraction


total score =

= SUM(weighted points for all 7 items)



• minimum score: 0

• maximum score: 9

• A score >= 2 gave the best positive predictive value for definite sepsis (52%). The positive predictive value was 65% for definite and/or probable sepsis.

• A score <= 1 had a negative predictive value of 85% for definite sepsis.


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