DETECTION OF POSTOPERATIVE SEPSIS IN INFANTS WITH THE USE OF METABOLIC STRESS MONITORING

Objectives: To evaluate the ability of serial protein metabolic monito ring to detect postoperative injury due to serious bacterial infection in infants by comparing changes observed in these protein parameters with more conventionally accepted indexes of infection. Design: Retros pective review of infants whose postoperative course was complicated b y bacterial infection compared with a matched cohort of infants in who m bacterial infection did not develop postoperatively. Setting: Neonat al and pediatric intensive care units at the Wake Forest University Me dical Center, Winston-Salem, NC. Patients: Critically ill infants (N=4 0) recovering from major surgical intervention. Main Outcome Measures: Serum C-reactive protein, prealbumin, and tumor necrosis factor conce ntrations were compared with the white blood cell count, immature-tota l neutrophil ratio, and body temperature obtained within 24 hours befo re and following the new onset of culture-established postoperative ba cterial infection in 13 infants. These infants were compared with a ma tched cohort of 27 infants in whom postoperative bacterial infection d id not develop. Results: Only C-reactive protein (P=.0001) and prealbu min (P=.0003) levels were significantly altered in association with th e onset of serious bacterial infection (paired t test). The C-reactive protein levels were clearly superior to all other variables in predic ting postoperative infection (at cutoff point >6.0 mg/dL; sensitivity, 92%; specificity, 96%). The predictive power of prealbumin level was lower, but acceptable (at cutoff point less than or equal to 9.0 mg/dL ; sensitivity, 85%; specificity, 74 %) Conclusions: Monitoring of seri al protein metabolic stress with C-reactive protein and prealbumin lev els in infants following operations is more effective than the white b lood cell count, immature-total neutrophil ratio, or temperature in de tecting serious postoperative infections.