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BackgroundCurrently, there is a lack of clear definition for neonatal sepsis. The Pediatric Committee of the European Medicines Agency (EMA) developed consensus criteria to ensure a standardization for neonatal sepsis definition. However, there is no evidence supporting the accuracy of the EMA sepsis criteria in neonatal sepsis diagnosis. The main objective of this study was to evaluate the diagnostic accuracy of EMA sepsis criteria for proven neonatal sepsis.MethodsA multicenter prospective cohort study was conducted from October 2015 to November 2018. Infants with a gestational age over 34th weeks, diagnosed with clinical sepsis and received antibiotics according to the EMA criteria or experienced neonatologists' opinion were included. Blood culture or multiplex real time-PCR or 16S-rRNA positive infants were accepted as "proven sepsis". The predictive performance of EMA criteria for proven sepsis was evaluated by sensitivity, specificity, accuracy, and area under the curve measures of receiver operator characteristic curves. Data-mining methods were used for further analysis.ResultsAmong the 245 included infants, the EMA criteria were positive in 97 infants (39.6%), while proven sepsis was diagnosed in 113 infants (46.1%). The sensitivity, specificity, and accuracy of the EMA criteria for proven sepsis were 44.2% (95%CI: 34.9-53.9), 64.4% (95%CI: 55.6-72.5), 55.1% (95%CI: 46.6-59.4) respectively. None of the clinical and laboratory parameters had sufficient performance individually in terms of sensitivity, specificity and accuracy measures. The diagnostic performance was similar when different clinical findings were added to the EMA sepsis criteria or assessment of the score was interpreted in different ways.ConclusionsResults highlighted that clinician opinion and standard laboratory tests are limited in the neonatal sepsis diagnosis. The EMA criteria also did not efficiently meet the diagnostic accuracy measures for neonatal sepsis. A predictive sepsis definition and rapid bedside point-of care tests are urgently needed.

Aim:Pediatric hypertension, a public health concern, is now commonly known worldwide to be an early risk factor for cardiovascular and renal morbidity and mortality. Early detection of hypertension is of the utmost importance to help reduce serious complications. Several distributions of country-specific blood pressure (BP) percentiles have been established worldwide. The aim of this study is to determine BP percentiles in healthy Turkish children aged 2 to 18 years.Materials and Methods:In this cross-sectional study, BP was measured in 4,984 randomly selected children and adolescents aged 2-17 years. The 50th, 90th and 95th percentile of BP percentiles were determined for gender, age and height with the use a polynomial regression model. BP percentiles at median height were compared with the US Fourth Report references.Results:The normative values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased with age for both genders and varied by gender. At median height, the age-specific differences at the 90th percentile of SBP tended to be higher in boys than in girls at all ages. DBP values in girls were higher than in boys until the age of 9 years, after which boys demonstrated higher values compared to girls.Conclusion:The age and height specific reference BP values determined in this study is a novel reference for Turkish children and adolescents. Turkish BP values are lower than existing US reference values.