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Neurological sequelae of healthcare-associated sepsis in very-low-birthweight infants: Umbrella review and evidence-based outcome tree
- Sebastian Haller1 , Philipp Deindl2 , Alessandro Cassini3 , Carl Suetens3 , Walter Zingg4 , Muna Abu Sin1 , Edward Velasco1 , Bettina Weiss1 , Tanja Ducomble1 , Madlen Sixtensson1 , Tim Eckmanns1 , Thomas Harder1
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View Affiliations Hide AffiliationsAffiliations: 1 Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany 2 Department of Neonatology and Pediatric Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany 3 European Centre for Disease Prevention and Control, Stockholm, Sweden 4 Infection Control Programme, University Hospitals of Geneva, SwitzerlandThomas Harderhardert rki.de
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Citation style for this article: Haller Sebastian, Deindl Philipp, Cassini Alessandro, Suetens Carl, Zingg Walter, Abu Sin Muna, Velasco Edward, Weiss Bettina, Ducomble Tanja, Sixtensson Madlen, Eckmanns Tim, Harder Thomas. Neurological sequelae of healthcare-associated sepsis in very-low-birthweight infants: Umbrella review and evidence-based outcome tree. Euro Surveill. 2016;21(8):pii=30143. https://doi.org/10.2807/1560-7917.ES.2016.21.8.30143 Received: 06 Feb 2015; Accepted: 30 Sept 2015
Abstract
Sepsis is a frequent cause of death in very-low-birthweight infants and often results in neurological impairment. Its attributable risk of sequelae has not been systematically assessed. To establish an outcome tree for mapping the burden of neonatal sepsis, we performed systematic literature searches to identify systematic reviews addressing sequelae of neonatal sepsis. We included cohort studies and performed meta-analyses of attributable risks. Evidence quality was assessed using GRADE. Two systematic reviews met inclusion criteria. The first included nine cohort studies with 5,620 participants and five outcomes (neurodevelopmental impairment, cerebral palsy, vision impairment, hearing impairment, death). Pooled risk differences varied between 4% (95% confidence interval (CI):2–10) and 13% (95% CI:5–20). From the second review we analysed four studies with 472 infants. Positive predictive value of neurodevelopmental impairment for later cognitive impairment ranged between 67% (95% CI:22–96) and 83% (95% CI:36–100). Neonatal sepsis increases risk of permanent neurological impairment. Effect size varies by outcome, with evidence quality being low to very low. Data were used to construct an outcome tree for neonatal sepsis. Attributable risk estimates for sequelae following neonatal sepsis are suitable for burden estimation and may serve as outcome parameters in interventional studies.
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