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Poster Display - 77
Optimizing resource utilization in low- and middle-income country NICUs: a clinical audit of surgical infection screening practices at a high-volume NICU in Pakistan
Humza Thobani 1, Rafia Durrani 2, Sulaiman Sajjad 3, Muhammad Osama Khan 2, Javeria Javed 2, Zahra Iftikhar 2, Muhammad Aqil Soomro 2, Saqib Qazi 2, Faraz A . Khan 1, Saleem Islam 2
1 Division of Pediatric Surgery, Department of Surgery, Stanford University, Palo Alto, California
2 Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
3 Medical College, Aga Khan University, Karachi, Pakistan
Purpose: Post operative sepsis in neonates is a serious problem that may be challenging to diagnose and has led to a multitude of tests and evaluations performed which may be unhelpful. These tests often require additional assessment to verify and may add to the confusion. It is standard practice at our Neonatal Intensive Care Unit (NICU) to perform routine Blood Cultures (BLCS) and C-Reactive Protein (CRP) on all post-operative neonates to screen for sepsis. We aimed to review this practice to investigate whether it was a truly effective screening tool.
Methods: All neonates admitted to the NICU post-operatively at our center from 2017-2022 were included. Relevant clinical and demographic data were collected. The sensitivity of BLCS was calculated for each post-operative day (POD) and an ROC curve was constructed for overall CRP values to quantify their screening value.
Results: A total of 109 post-operative neonates with the median gestational age and birth weight of 37 weeks (IQR 34 – 40) and 2.4kg (IQR: 2.0 – 2kg) were included in this study. 13 (12.6%) of them developed sepsis. All patients underwent BLCS and CRP screening immediately after surgery. Only 2 patients had growth of pathological microbes on POD 0 or 1, both of whom had growth on preoperative BLCS as well. BLCS sensitivity increased significantly after POD 2. CRP levels were elevated and varied, with poor discrimination for post-operative sepsis (AUROC=0.55, p=0.102).
Conclusion: Routine BLCS performed immediately after surgery did not predict onset of post-operative sepsis. CRP performed poorly at discriminating post-operative sepsis, likely due to physiologic inflammation in post-operative neonates. Unnecessary screening tests for post-operative neonates represent a significant financial burden on patients and healthcare systems in LMICs, with little to no clear clinical benefit, with the potential for harm due to false positive results.