1.1.4.1. Included studies

A joint search was carried out to identify studies specified for this evidence review, and a similar evidence review for studies assessing clinical prediction models for late-onset infection (for details, see evidence review E – Risk factors for late onset). This returned a total of 1,252 results, of which 68 were identified as potential included studies. Full text articles were ordered and reviewed against the inclusion criteria, of which 7 met the inclusion criteria for the review. Two additional studies were included from a systematic review making 9 included references in total.

The search was re-run in July 2020 to identify any studies which had been published since the date of the original search. This combined search for early- and late-onset prediction models returned a total of 244 results of which 14 were identified as possible included studies. After full text review, 13 were excluded. The one included study examined the use of a clinical prediction model for early-onset infection. In total there were therefore 10 studies which met the inclusion criteria for this review (5 prospective cohort studies, 5 retrospective cohort studies).

The majority of the evidence (9 studies) investigated the use of the Kaiser Permanente neonatal sepsis calculator, including one study that compared the prognostic accuracy of the calculator against the recommendations from the 2012 version of this guideline. One study examined the use of a different model, based on various demographic and clinical factors. Studies reported the information needed to calculate prognostic outcomes for sensitivity, specificity and likelihood ratios. Only one study reported model fit statistics (c-statistic), and none reported hazard or odds ratios. No studies matched the protocol for Part B of the review (RCTs for different risk predictor tools).

1.1.4.2. Excluded studies

See Appendix J for excluded studies and reasons for exclusion.

1.1.6.1. Model summaries

1.1.6.2. Summary of clinical findings included in the evidence review

Table

Sensitivity, specificity and likelihood ratios.

Table

C-statistics.

See appendix F for full GRADE tables.

1.1.7.1. Included studies

A single search was performed to identify published economic evaluations of relevance to any of the questions in this guideline update (see Appendix B). This search retrieved 4,398 studies. Based on title and abstract screening, all of the studies could confidently be excluded for this question, as none of them were found to be relevant.

The search was re-run in July 2020 to identify any studies which had been published since the date of the original search. This returned a total of 577 results. Based on title and abstract screening, all the studies could confidently be excluded for this question. Thus, the review for this question does not include any study from the existing literature.

2.1.4.1. Included studies

A joint search was carried out to identify studies specified for this review question, and a similar review question for studies assessing risk factors and signs and symptoms in the baby for early-onset infection (for details, see section 3.1 of this evidence review). This returned a total of 1,825 results, of which 55 were identified as potential included studies. Full text articles were ordered and reviewed against the inclusion criteria, of which 11 met the inclusion criteria for this review.

The search was re-run in July 2020 to identify any studies which had been published since the date of the original search. This combined search for late-onset maternal and fetal risk factors and risk factors in the baby returned a total of 143 results, of which 3 were identified as possible included studies. After full text review, all 3 were excluded. In total there were therefore 11 studies which met the inclusion criteria for this review (3 prospective cohort studies, 8 retrospective cohort studies). No studies reported predictive accuracy data and so prognostic association data was considered instead.

Most of the multivariate cohort studies identified reported on the association between early-onset neonatal infection and chorioamnionitis (6 studies) or singleton births (3 studies). One study reported on the association between maternal obesity and early-onset infection and another examined the effects of intrapartum fever.

2.1.4.2. Excluded studies

See Appendix J for excluded studies and reasons for exclusion.

2.1.7.1. Included studies

A single search was performed to identify published economic evaluations of relevance to any of the questions in this guideline update (see appendix B). This search retrieved 4,398 studies. Based on title and abstract screening, all of the studies could confidently be excluded for this question, as none of them were found to be relevant.

The search was re-run in July 2020 to identify any studies which had been published since the date of the original search. This returned a total of 577 results. Based on title and abstract screening, all the studies could confidently be excluded for this question. Thus, the review for this question does not include any study from the existing literature.

3.1.4.1. Included studies

A joint search was carried out to identify studies specified for this review question, and a similar review question for studies assessing maternal and fetal risk factors for early-onset infection (for details, see section 2.1). This returned a total of 1,825 results, of which 55 were identified as potential included studies. Full text articles were ordered and reviewed against the inclusion criteria, of which 4 met the inclusion criteria for this review. No studies reported diagnostic or predictive accuracy data.

The search was re-run in July 2020 to identify any studies which had been published since the date of the original search. This combined search for late-onset maternal and fetal risk factors, and risk factors in the baby returned a total of 143 results, of which 3 were identified as possible included studies. After full text review, all 3 were excluded. In total there were therefore 4 studies which met the inclusion criteria for this review (1 prospective cohort study, 3 retrospective cohort studies). No studies reported predictive accuracy data and so prognostic and diagnostic association data was considered instead.

Of the 4 multivariate cohort studies identified, most were prognostic and reported on the association between early-onset neonatal infection and gestational age (3 studies). One diagnostic study reported on the association between respiratory distress syndrome and early-onset infection.

3.1.4.2. Excluded studies

See Appendix J for excluded studies and reasons for exclusion.

3.1.6.1. Risk factors

3.1.6.2. Signs and symptoms

See appendix F for full GRADE tables.

3.1.7.1. Included studies

A single search was performed to identify published economic evaluations of relevance to any of the questions in this guideline update (see appendix B). This search retrieved 4,398 studies. Based on title and abstract screening, all of the studies could confidently be excluded for this question, as none of them were found to be relevant.

The search was re-run in July 2020 to identify any studies which had been published since the date of the original search. This returned a total of 577 results. Based on title and abstract screening, all the studies could confidently be excluded for this question. Thus, the review for this question does not include any study from the existing literature.

4.1.2.1. Clinical prediction models

The outcomes from the evidence for prognostic models ranged from high to very low quality, with most outcomes either low or very-low quality. The quality of outcomes were commonly downgraded for imprecision in the results and for including studies at moderate risk of bias. All of the studies were directly applicable to the research question. Most of the evidence examined the use of the Kaiser Permanente neonatal sepsis calculator, with only one study reporting the details of a different prognostic model. One other study also compared the use of the calculator to the NICE recommendations. The committee therefore decided that only the neonatal sepsis calculator had sufficient evidence to be considered as an alternative to the NICE risk factors and clinical indicators.

Four studies examined the use of the Kaiser Permanente neonatal sepsis calculator in all babies over 34-, 35- or 36-weeks’ gestational age. Five studies examined the use of the calculator specifically for babies who were born to mothers with chorioamnionitis. The committee discussed whether the results from the chorioamnionitis studies could be applied to all babies but, as the results did not differ greatly from the three studies that included all babies, the committee thought that the results could be generalised. Six of the studies in the review were based in the USA where the calculator was developed. Only one study (Goel 2020) examined the use of the calculator in the UK. The committee discussed whether differences in the demographics of the population, in addition to differences in group B streptococcal (GBS) screening policies, could mean that the outcomes of the calculator may differ between the UK and the USA. GBS status is one of the factors in the neonatal sepsis calculator and the committee were unsure whether the unknown status in the UK would make assumptions about the mother that might change the outcome of the neonatal sepsis calculator. However, GBS status only contributes approximately 2% to the predictive weight of the model. This, in addition to the similarities in results between the UK study and the USA validation studies, meant that the committee did not feel it should recommend against the use of the neonatal sepsis calculator based on GBS status.

An important aspect of the neonatal sepsis calculator is the need for clinicians to enter a background rate for the incidence of early-onset neonatal infection. Further research is needed in the UK to identify what rate should be applied to reflect the local prevalence of neonatal infection, and whether this should be a single rate that is used across the UK or if it should vary by hospital. The committee did not feel that this should be a reason to recommend against the use of the neonatal sepsis calculator but potential differences in the incidence rate of infection between the UK and the USA, and the differences in GBS screening policies, meant that the studies that reported on the use of the calculator in the USA were downgraded as being partially applicable to the research question. The committee decided that the rate of infection should be considered as part of future research into the use of the neonatal sepsis calculator in the UK. This will help to ensure the accuracy of the outcomes of the calculator when used in NHS practice. For clinicians who are currently using the calculator, the committee decided to recommend that they should use either the national or local rate of infection, whichever is higher. This will help to increase the sensitivity of the calculator, thereby reducing the risk of a baby who has infection not being recommended for antibiotic treatment.

The imprecision of some of the results from the neonatal sepsis calculator studies was discussed, particularly when comparing the overall results of the calculator to the NICE guidelines. The neonatal sepsis calculator identified a slightly lower number of true positives to the NICE guidelines, and the likelihood ratios indicated that a positive outcome with the neonatal sepsis calculator would indicate a slightly higher chance of a baby having infection than a positive test from the NICE guidelines. However, the wide confidence intervals suggested variation in the results. This was particularly evident for the negative likelihood ratio for the NICE guidelines, which suggested that a negative outcome would indicate anything between a large decrease in the probability of a baby having infection to a slight increase in their chance of having infection. This made it difficult for the committee to decide on recommendations based on likelihood ratios alone. This imprecision in the results may be due to the very low incidence of culture-confirmed early-onset neonatal infection in the studies, with many studies reporting only one baby with a confirmed infection. Given that both the NICE recommendations and the neonatal sepsis calculator were associated with a wide degree of imprecision, the committee did not think this should be a reason against recommending the neonatal sepsis calculator. Instead, they decided to recommend that the risk factors specified in boxes 1 and 2 is used to identify babies at risk of early-onset infection, but also stated that if the calculator is being used in clinical practice it should be used as part of a clinical audit. This will help give a clearer understanding of its effectiveness. Examples of the outcomes that should be collected in an audit (number of babies assessed using the calculator and number of true positive, false positive and false negative results when using the calculator) were included in the recommendation to ensure that the most relevant information on effectiveness is available. These outcomes were chosen as the ones needed to form a 2 x 2 table to examine the effectiveness of a prognostic tool. This information will be useful in future updates of this guideline to decide whether a stronger recommendation can be made in favour of the use of the Kaiser Permanente neonatal sepsis calculator.

Given the issues discussed above, the committee agreed that more evidence is needed before it could recommend the Kaiser Permanente neonatal sepsis calculator as the sole option for predicting risk of early-onset neonatal infection in the UK. More research is particularly important for babies born before 34 weeks’ gestational age, as the neonatal sepsis calculator is only designed for babies born at a gestational age of 34 weeks or above. As such, the committee could not recommend the use of the calculator for this group of babies and this was stated as part of the calculator recommendations. Instead, a research recommendation relating to prognostic models was made which did not specify gestational age (Appendix K). This should help to ensure that the most effective prognostic tool can be determined for all babies, and not just those covered by the calculator.

4.1.2.2. Maternal and neonatal risk factors and clinical indicators

The evidence for risk factors and signs and symptoms ranged from high to low quality and most studies were directly applicable to the research question. Each of the studies reported the use of a multivariate model but there was a wide range in the factors that the models were adjusted for, and most studies did not explain why those particular factors were chosen. The committee agreed that this could affect the validity of the data and so the quality of the outcomes from these studies were downgraded for risk of bias. However, the factors that were highlighted as potential risks for infection were consistent with their clinical experience. As such, they decided that they could still be identified as risk factors in the recommendations.

There was also variation in the populations that were included in each study, with some basing the inclusion criteria on gestational age or birthweight while other studies included all babies born in a particular setting. Consequently, the results were presented by individual study outcomes rather than pooled effect estimates. An additional issue was that many studies only reported the significant results from the models. This means that while one study may have reported an association between a particular factor and neonatal infection, it is unclear how many other studies also investigated that risk factor but found non-significant results. Where studies only reported significant results, they were therefore downgraded for risk of bias. The committee decided that risk factors would only be included as part of the recommendations if the evidence corresponded with their clinical experience.

Only one study examined the effects of maternal obesity on the risk of early-onset neonatal infection. The committee questioned the applicability of this research as mothers who were included in the analysis were grouped by the World Health Organisation definition of obesity (BMI of 30.0 and above). It was highlighted that in clinical practice maternal obesity is now often defined as women with a BMI of 35 and above. Due to these differences in classification, this study was graded as partially applicable to the research question and the quality of the outcomes were downgraded. With such limited and partially applicable evidence, the committee decided that more relevant research was needed before recommendations could be made on maternal obesity and neonatal infection. A research recommendation was therefore made to reflect this (Appendix K).

The committee discussed the criteria for chorioamnionitis that was used in the research. Many studies used the Gibbs criteria or similar, and this is known to have relatively low sensitivity. It was raised that these criteria do not reflect the complexities of diagnosing chorioamnionitis in clinical practice where clinicians tend to look for more subtle signs to enable earlier diagnosis and treatment. These differences in definition may change the association between chorioamnionitis and neonatal infection. However, the committee was confident that its clinical experience supported the findings that chorioamnionitis is a risk factor for neonatal infection. They therefore agreed that these studies should remain applicable to the research question and that chorioamnionitis should remain part of the maternal risk factors table.

The studies which examined individual risk factors examined a wider range of populations, including babies born before 34 weeks’ gestational age. As a result, the risk factor tables and their accompanying recommendations can be used for babies of any gestational age, including the population that are not covered by the neonatal sepsis calculator.

4.1.3.1. Clinical prediction models

The main concern of the committee in relation to any prognostic model or management tool for neonatal infection was the trade-off between the potential issues associated with over-treatment versus the risks from lack of treatment where a baby does have infection. Although there are harms associated with unnecessary antibiotic treatment, such as the potential for nephrotoxicity when a baby is given gentamicin, and increased length of stay in hospital, the committee decided that these were smaller than the risk of a baby not receiving treatment when they do have infection. It is therefore important that any clinical prediction model or framework can maximise the number of babies that are correctly identified as needing treatment, while minimising the number who are given antibiotics unnecessarily.

Most of the data on clinical prediction models was for the Kaiser Permanente neonatal sepsis calculator. The committee agreed that overall pooled results from 9 studies showed that the tool had good specificity, but that there was substantial uncertainty about the sensitivity, with wide confidence intervals in the results. The positive likelihood ratio was above the clinical decision threshold, suggesting that a positive test result from the neonatal sepsis calculator indicated a large to very large increase in the probability of a baby having infection. However, the negative likelihood ratio was on the clinical decision threshold, and so the committee thought that more research was needed before the calculator could be considered as the sole option for predicting a baby’s risk of infection. One UK study compared the predictive accuracy of the Kaiser Permanente neonatal sepsis calculator with the recommendations in the 2012 guideline on neonatal infection, and the committee placed particular weight on this study when making recommendations. This study showed that both tools had similar sensitivity, but that the specificity of the neonatal sepsis calculator was higher, suggesting that using the neonatal sepsis calculator may result in fewer babies being treated with antibiotics who do not have infection. However, data on sensitivity were very uncertain because of the low number of cases of culture confirmed early-onset neonatal infection. This was particularly the case for the framework outlined in the 2012 NICE guideline which had data from only a single study with just 6 cases of confirmed neonatal infection. Given the uncertainties in the evidence, the committee decided that a recommendation for a framework based on individual factors was appropriate, with an option for obstetric or paediatric centres to consider the Kaiser Permanente neonatal sepsis calculator as part of an audit which assesses and manages the risk of neonatal infection. The committee thought that using a framework based on individual risk factors (described in more detail in the section below) was likely to be a conservative approach which would result in more antibiotics being prescribed that the neonatal sepsis calculator, but might also identify more true cases of infection. However, as the evidence did not show one option to be clearly better than the other, and as the neonatal sepsis calculator is already used in some centres in the UK, the committee decided that the recommendation to use the calculator in the context of an audit was appropriate, as long as this was for babies with a gestational age of 34 weeks and above. In situations where the Kaiser Permanente neonatal sepsis calculator is used, the committee decided that clinicians should use the recommendations within the tool to decide whether to treat with antibiotics or monitor further, as the evidence included as part of this review is based on these categorisations.

An additional aspect of the recommendation for use of the Kaiser Permanente calculator is that is should only be used for babies who are being cared for in a neonatal unit (neonatal intensive care units, local neonatal units and special care units), transitional care or postnatal ward. The committee did not think the calculator should be recommended for use in the emergency department or other settings, as babies who are brought in from home are likely to already be showing signs of being unwell and therefore need more immediate treatment than babies who are being assessed for risk of infection in a neonatal unit. In these cases, waiting to consult the calculator could instead delay treatment.

Given the limited evidence on clinical prediction models in the UK (including the Kaiser Permanente neonatal sepsis calculator as well as the framework set out by NICE), the committee decided that a research recommendation was needed for the use of prognostic tools for early-onset neonatal infection specifically in the UK. This recommendation was for any prognostic model, meaning that other models can be designed and evaluated, which may be particularly important for specific populations, such as babies born before 34 weeks gestational age (Appendix K).

4.1.3.2. Individual risk factors and clinical indicators

The committee decided that current evidence was not sufficient to make recommendations based only on clinical prediction models, so they also reviewed the evidence on individual risk factors and signs and symptoms of early-onset neonatal infection. The committee agreed that the structure of the recommendations outlined in the 2012 version of this guideline was still appropriate, with tables of risk factors and clinical indicators, some of which were designated as ‘red flag’ indicators. Red flag indicators were selected based on committee experience and are those thought to be the most high risk factors that require immediate treatment. Non-red flag indicators are those that can have causes other than neonatal infection and therefore do not always signal the need for immediate treatment. They decided that the recommendations in the 2012 version of this guideline on when to start antibiotic treatment or carry out further monitoring based on the number of indicators and red flag indicators met were still appropriate, and so made recommendations that were very similar to those made previously.

The committee thought it was important to retain the separate tables for risk factors and for clinical indicators that were used in the 2012 version of the guideline. The risk factors list (Box 1) gives an indication of the factors that a clinician should be aware of before the birth and the clinical indicators list (Box 2) highlights the signs and symptoms to look for in the baby after birth. Separating risk factors and clinical indicators should make it clearer for clinicians when they are trying to make important decisions about whether a baby should be treated for neonatal infection. Although the committee decided to keep the format of the recommendations the same as the previous version of the guideline, they made some changes to the risk factors and clinical indicators based on the updated evidence and their knowledge and experience. These changes are outlined in the sections below.

4.1.3.3. Maternal risk factors

When presented with the evidence for maternal risk factors, the committee decided to use a modified version of the risk factors table used in the 2012 version of the guideline (Box 1), as the main factors identified as risks for neonatal infection in the evidence review (intrapartum fever and chorioamnionitis) were already included in the table. Intrapartum fever and chorioamnionitis were a single risk factor in the 2012 guideline but, based on their clinical experience, the committee decided to separate these into two risk factors, as fever can also indicate other bacterial infections that are not chorioamnionitis. However, it specified that fever should only be considered a risk factor when there is suspected bacterial infection. This will avoid women who have a high temperature for other reasons, such as the side-effects of an epidural, receiving antibiotics unnecessarily. The committee also discussed how a woman can have chorioamnionitis without having fever, and this should be considered a risk factor for infection. There was discussion about whether this separation of fever and chorioamnionitis into separate risk factors would result in an increase in the number of women prescribed antibiotics. However, as women with both chorioamnionitis and fever would generally be given antibiotics in practice, the committee did not think this would result have a big impact on antibiotic prescription or resistance. The committee also updated the terminology for chorioamnionitis from suspected or confirmed chorioamnionitis to clinical chorioamnionitis, as a diagnosis during the intrapartum period is usually based on clinical signs rather than a histological diagnosis.

The committee decided to remove parenteral antibiotic treatment from the list of risk factors. This decision was made based on changes in obstetric practice since the previous guideline update, meaning that the threshold for diagnosing a mother with septicaemia is now lower. This means that many babies are now receiving antibiotics based on this red flag risk factor alone. This is considered to be an issue for the overprescribing of antibiotics.

The committee combined the risk factors ‘Invasive group B streptococcal infection in a previous baby’ and ‘maternal group B streptococcal colonisation, bacteriuria or infection in the current pregnancy’ into a single item in the list because they considered that these items relate to the same risk factor. Having a previous baby with invasive group B streptococcal infection does not increase the risk of neonatal infection further if a mother is known to have group B streptococcal colonisation, bacteriuria or infection in her current pregnancy, and so this should not be considered an additional risk factor.

The committee revised the table to make the sections on rupture of membranes at term and preterm clearer, and to reflect current NICE guidance in this area. Confirmed pre-labour rupture of membranes at term for more than 24 hours was included to correspond with the recommendations in the intrapartum care guideline (NICE clinical guideline 190, recommendation 1.11.6). However, the committee decided that the time period for confirmed rupture of membranes for more than 18 hours in a preterm birth should be retained (as in the 2012 version of the guideline) because there was no new evidence available in relation to this risk factor. Confirmed prelabour rupture of membranes was removed from the table because the committee felt that it is now covered by other risk factors in the table (preterm birth and confirmed rupture of membranes in a preterm or term birth). Consequently, they agreed that babies born to these mothers would still receive treatment when using the updated version of the NICE guidelines.

One other factor (single compared to multiple births) was identified in the evidence review. However, the committee did not think that it would be useful to highlight single births as a risk factor for infection, as this could result in most babies being identified as at higher risk of infection. It decided that there were other factors in the review that were more important to identify as potential risks for infection.

4.1.3.4. Neonatal risk factors and clinical indicators

The committee also reviewed the risk factors and clinical indicators in the baby for early-onset infection. They decided to recommend a modified version of the risk factors (Box 1) and clinical indicators (Box 2) tables used in the 2012 version of the guideline as a starting point to modify based on new evidence as appropriate.

One of the most common risk factors identified in the evidence review was low gestational age. The committee discussed whether this should be an additional risk factor but agreed that this is already covered by the preterm birth risk factor. It was highlighted that while there are a number of risk factors in the baby, many of these are as a result of low gestational age. The evidence suggested that babies born at less than 32 weeks’ gestational age are at greater risk of developing infection than those born at 32 weeks or greater. The committee discussed whether this should be added as additional information to the preterm birth factor, but it was deemed unnecessary as it would still count as one risk factor in the table. It was highlighted that babies who are slightly preterm and on a postnatal ward might be more at risk of an infection being missed because they might not be considered a high-risk group. The inclusion of babies born before 37 weeks’ gestation as a risk factor should therefore highlight to clinicians that these babies should be monitored for other signs of infection.

There was very little evidence on clinical indicators for early-onset infection and so the committee decided to base their recommendations on the table of clinical indicators in the 2012 version of the NICE guideline on neonatal infection. They made changes to this table based on their knowledge and experience and to make the table applicable to current practice (Box 2).

The committee decided to remove respiratory distress starting 4 hours after birth from the table of risk factors because they agreed that they would not want clinicians to wait 4 hours for treatment on the basis of this recommendation. Instead, they chose to retain ‘signs of respiratory distress’ as a factor in the table as this would include the group of babies who have symptoms beyond 4 hours after birth and should ensure that any babies who have infection will still receive the necessary treatment. The 2012 recommendations also had two recommendations for need for mechanical ventilation; one for preterm babies which was not a red flag risk factor and one for term babies which was a red flag. The committee agreed that mechanical ventilation is a risk factor for infection regardless of prematurity and so they decided to merge these into one recommendation which did not refer to whether a baby was born pre-term or at term for simplicity. They decided that this should be a red flag indicator.

For signs and symptoms in the baby, the committee decided to remove oliguria and local signs of infection from the recommendations table. Oliguria persisting beyond 24 hours after birth was removed because there is no clear definition of this risk factor, and the 24-hour time point is beyond the time when babies typically present with early-onset infection. The committee also considered oliguria to be a poor indicator of early-onset sepsis. The committee felt that local signs of infection should be removed because such infections are very common in newborn babies and including ‘local infection’ in the table may result in overprescribing antibiotics. Many local infections also require different management pathways to sepsis, such as oral or topical antibiotics.

4.1.3.5. Management of babies at increased risk of infection

The committee made recommendations based on their knowledge and experience that were consistent with the recommendations from the 2012 version of this guideline and current best practice. These recommendations were designed to direct clinicians to other, evidence-based, sections of the guideline where they could receive guidance when deciding whether a baby should be given antibiotic treatment, what antibiotics should be given, or what to do when discharging the baby if there are no further concerns.

The committee discussed how the recommendations for the use of the NICE risk factors and clinical indicators, or the neonatal sepsis calculator may result in some babies beginning to receive treatment when they do not have an infection. However, this risk is mitigated by clear recommendations in other sections of the guideline (recommendations 1.9.1–1.9.4) on when clinicians should stop giving antibiotics. This will minimise the time that a baby receives treatment if a negative blood culture result is returned. Recommendations on duration of antibiotics for early-onset infection were from the previous version of the guideline, and were thought to be appropriate in ensuring that babies receive necessary and timely treatment as well as making sure that treatment is stopped as soon as it is safe to do so. As such, the committee did not think that these needed to be changed.

Medline. Medline In Process, Medline E-pub

1. exp Infant, Newborn/
2. Term Birth/
3. Infant Care/
4. Perinatal Care/
5. Intensive Care Units, Neonatal/
6. Intensive Care, Neonatal/
7. Infant Health/
8. (newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*).tw.
9. ((premature or pre-mature* or preterm or pre-term) adj4 (child* or infant* or baby* or babies* or offspring)).tw.
10. or/1-9
11. exp Bacterial Infections/
12. ((bacter* or strep* or staph* or GNB) adj4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)).tw.
13. exp Sepsis/
14. (sepsis or septic?emia* or py?emia* or pyho?emia*).tw.
15. (septic* adj4 shock*).tw.
16. or/11-15
17. exp Streptococcus/
18. exp Staphylococcus/
19. (streptococc* or staphylococc*).tw.
20. (GBS or MRSA or NRCS-A or MSSA).tw.
21. (met?icillin-resistant adj3 aureus).tw.
22. exp Escherichia coli/
23. ((Escheric* or E) adj2 coli).tw.
24. exp Listeria/
25. listeria*.tw.
26. exp Klebsiella/
27. klebsiella*.tw.
28. exp Pseudomonas/
29. (pseudomonas or chryseomonas or flavimonas).tw.
30. Enterobacteriaceae/
31. (enterobact* or sodalis or paracolobactrum or ewingella or leclercia).tw.
32. ((enteric or coliform) adj2 bac*).tw.
33. exp Neisseria/
34. neisseria*.tw.
35. exp Haemophilus influenzae/
36. ((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) adj2 (influenz* or pfeiffer* or meningitidis)).tw.
37. exp Serratia/
38. serratia*.tw.
39. exp Cronobacter/
40. (cronobact* or sakazaki* or malonatic*).tw.
41. exp Acinetobacter/
42. (acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*).tw.
43. exp Fusobacterium/
44. (fusobact* or sphaerophor* or necrophorum or nucleatum).tw.
45. exp Enterococcus/
46. enterococc*.tw.
47. or/17-46
48. 16 or 47
49. 10 and 48
50. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) adj4 infect*).tw.
51. ((premature or pre-mature* or preterm or pre-term) adj4 (child* or infant* or baby* or babies* or offspring) adj4 infect*).tw.
52. 50 or 51
53. 49 or 52
54. (bacter?emia* or bacill?emia*).tw.
55. (blood* adj4 (infect* or contamin* or invas* or invad*)).tw.
56. 54 or 55
57. 10 and 56
58. 53 or 57
59. Risk Assessment/mt [Methods]
60. ((risk* or predict* or probab* or prognos* or quantitativ*) adj2 (model* or tool* or algorithm* or rul*)).tw.
61. (diagnos* adj2 (model* or algorithm*)).tw.
62. ((sepsis* or septic* or Bayes* or EOS or LOS) adj4 calculator*).tw.
63. (NEOSC or EOSCAL* or SRC).tw.
64. (Kaiser adj2 Permanente).tw.
65. (Kaiser adj10 calculator*).tw.
66. ((sepsis or septic*) adj4 risk* adj4 scor*).tw.
67. SRS.tw.
68. ((sepsis* or septic*) adj4 (metascore* or meta-score*)).tw.
69. Diagnosis, Computer-Assisted/
70. Algorithms/
71. ((computer* or vital signs* or math* or manag* or clinic* or medic* or stratif* or prevent* or therap*) adj4 algorithm*).tw.
72. RALIS.tw.
73. (computer* adj4 (analys* or template*)).tw.
74. Decision Support Techniques/
75. (decision* adj4 (aid* or analys* or support* or assist*)).tw.
76. CDSS*.tw.
77. or/59-76
78. 58 and 77
79. Animals/ not Humans/
80. 78 not 79
81. limit 80 to english language

Embase

1. newborn/
2. term birth/
3. infant care/
4. perinatal care/
5. neonatal intensive care unit/
6. newborn intensive care/
7. child health/
8. (newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*).tw.
9. ((premature or pre-mature* or preterm or pre-term) adj4 (child* or infant* or baby* or babies* or offspring)).tw.
10. or/1-9
11. exp bacterial infection/
12. ((bacter* or strep* or staph* or GNB) adj4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)).tw.
13. exp sepsis/
14. (sepsis or septic?emia* or py?emia* or pyho?emia*).tw.
15. (septic* adj4 shock*).tw.
16. or/11-15
17. exp Streptococcus/
18. exp Staphylococcus/
19. (streptococc* or staphylococc*).tw.
20. (GBS or MRSA or NRCS-A or MSSA).tw.
21. (met?icillin-resistant adj3 aureus).tw.
22. exp Escherichia coli/
23. ((Escheric* or E) adj2 coli).tw.
24. exp Listeria/
25. listeria*.tw.
26. exp Klebsiella/
27. klebsiella*.tw.
28. exp Pseudomonas/
29. (pseudomonas or chryseomonas or flavimonas).tw.
30. Enterobacteriaceae/
31. (enterobact* or sodalis or paracolobactrum or ewingella or leclercia).tw.
32. ((enteric or coliform) adj2 bac*).tw.
33. exp Neisseria/
34. neisseria*.tw.
35. exp Haemophilus influenzae/
36. ((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) adj2 (influenz* or pfeiffer* or meningitidis)).tw.
37. exp Serratia/
38. serratia*.tw.
39. exp cronobacter/
40. (cronobact* or sakazaki* or malonatic*).tw.
41. exp Acinetobacter/
42. (acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*).tw.
43. exp Fusobacterium/
44. (fusobact* or sphaerophor* or necrophorum or nucleatum).tw.
45. exp Enterococcus/
46. enterococc*.tw.
47. or/17-46
48. 16 or 47
49. 10 and 48
50. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) adj4 infect*).tw.
51. ((premature or pre-mature* or preterm or pre-term) adj4 (child* or infant* or baby* or babies* or offspring) adj4 infect*).tw.
52. 50 or 51
53. 49 or 52
54. (bacter?emia* or bacill?emia*).tw.
55. (blood* adj4 (infect* or contamin* or invas* or invad*)).tw.
56. 54 or 55
57. 10 and 56
58. 53 or 57
59. *risk assessment/
60. ((risk* or predict* or probab* or prognos* or quantitativ*) adj2 (model* or tool* or algorithm* or rul*)).tw.
61. (diagnos* adj2 (model* or algorithm*)).tw.
62. ((sepsis* or septic* or Bayes* or EOS or LOS) adj4 calculator*).tw.
63. (NEOSC or EOSCAL* or SRC).tw.
64. (Kaiser adj2 Permanente).tw.
65. (Kaiser adj10 calculator*).tw.
66. ((sepsis or septic*) adj4 risk* adj4 scor*).tw.
67. SRS.tw.
68. ((sepsis* or septic*) adj4 (metascore* or meta-score*)).tw.
69. computer assisted diagnosis/
70. algorithm/
71. ((computer* or vital signs* or math* or manag* or clinic* or medic* or stratif* or prevent* or therap*) adj4 algorithm*).tw.
72. RALIS.tw.
73. (computer* adj4 (analys* or template*)).tw.
74. exp decision support system/
75. (decision* adj4 (aid* or analys* or support* or assist*)).tw.
76. CDSS*.tw.
77. or/59-76
78. 58 and 77
79. nonhuman/ not human/
80. 78 not 79
81. limit 80 to english language
82. limit 81 to (conference abstract or conference paper or “conference review”)
83. 81 not 82

Cochrane Database of Systematic Reviews, CENTRAL

#1.

MeSH descriptor: [Infant, Newborn] explode all trees

#2.

MeSH descriptor: [Term Birth] this term only

#3.

MeSH descriptor: [Infant Care] this term only

#4.

MeSH descriptor: [Perinatal Care] this term only

#5.

MeSH descriptor: [Intensive Care Units, Neonatal] this term only

#6.

MeSH descriptor: [Intensive Care, Neonatal] this term only

#7.

MeSH descriptor: [Infant Health] this term only

#8.

((newborn* or new born* or new-born or neonat* or neo-nat* or perinat* or peri-nat*)):ti,ab,kw

#9.

((premature or pre-mature* or preterm or pre-term) near/4 (child* or infant* or baby* or babies* or offspring)):ti,ab,kw

#10.

{or #1-#9}

#11.

MeSH descriptor: [Bacterial Infections] explode all trees

#12.

((bacter* or strep* or staph* or GNB) near/4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)):ti,ab,kw

#13.

MeSH descriptor: [Sepsis] explode all trees

#14.

((sepsis or septic?emia* or py?emia* or pyho?emia*)):ti,ab,kw

#15.

((septic* near/4 shock*)):ti,ab,kw

#16.

{or #11-#15}

#17.

MeSH descriptor: [Streptococcus] explode all trees

#18.

MeSH descriptor: [Staphylococcus] explode all trees

#19.

((streptococc* or staphylococc*)):ti,ab,kw

#20.

((GBS or MRSA or NRCS-A or MSSA)):ti,ab,kw

#21.

((met?icillin-resistant near/3 aureus)):ti,ab,kw

#22.

MeSH descriptor: [Escherichia coli] explode all trees

#23.

((Escheric* or E) near/2 (coli)):ti,ab,kw

#24.

MeSH descriptor: [Listeria] explode all trees

#25.

(Listeria*):ti,ab,kw

#26.

MeSH descriptor: [Klebsiella] explode all trees

#27.

(klebsiella*):ti,ab,kw

#28.

MeSH descriptor: [Pseudomonas] explode all trees

#29.

((pseudomonas or chryseomonas or flavimonas)):ti,ab,kw

#30.

MeSH descriptor: [Enterobacteriaceae] this term only

#31.

((enterobact* or sodalis or paracolobactrum or ewingella or leclercia)):ti,ab,kw

#32.

((enteric or coliform) near/2 (bac*)):ti,ab,kw

#33.

MeSH descriptor: [Neisseria] explode all trees

#34.

(neisseria*):ti,ab,kw

#35.

MeSH descriptor: [Haemophilus influenzae] explode all trees

#36.

((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) near/2 (influenz* or pfeiffer* or meningitidis)):ti,ab,kw

#37.

MeSH descriptor: [Serratia] explode all trees

#38.

(serratia*):ti,ab,kw

#39.

MeSH descriptor: [Cronobacter] explode all trees

#40.

((cronobact* or sakazaki* or malonatic*)):ti,ab,kw

#41.

MeSH descriptor: [Acinetobacter] explode all trees

#42.

((acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*)):ti,ab,kw

#43.

MeSH descriptor: [Fusobacterium] explode all trees

#44.

((fusobact* or sphaerophor* or necrophorum or nucleatum)):ti,ab,kw

#45.

MeSH descriptor: [Enterococcus] explode all trees

#46.

(enterococc*):ti,ab,kw

#47.

{or #17-#46}

#48.

#16 or #47

#49.

#10 and #48

#50.

((newborn* or new born* or new-born* or neonat* or neo-nat* or perinat* or peri-nat*) near/4 (infect*)):ti,ab,kw

#51.

((premature or pre-mature* or preterm or pre-term) near/4 (child* or infant* or baby* or babies* or offspring) near/4 (infect*)):ti,ab,kw

#52.

#50 or #51

#53.

#49 or #52

#54.

((bacter?emia* or bacill?emia*)):ti,ab,kw

#55.

((blood*) near/4 (infect* or contamin* or invas* or invad*)):ti,ab,kw

#56.

#54 or #55

#57.

#10 and #56

#58.

#53 or #57

#59.

MeSH descriptor: [Risk Assessment] this term only and with qualifier(s): [methods - MT]

#60.

((risk* or predict* or probab* or prognos* or quantitativ*) near/2 (model* or tool* or algorithm* or rul*)):ti,ab,kw

#61.

((diagnos*) near/2 (model* or algorithm*)):ti,ab,kw

#62.

((sepsis* or septic* or Bayes* or EOS or LOS) near/4 (calculator*)):ti,ab,kw

#63.

((NEOSC or EOSCAL* or SRC)):ti,ab,kw

#64.

((Kaiser) near/2 (Permanente)):ti,ab,kw

#65.

((Kaiser) near/10 (calculator*)):ti,ab,kw

#66.

((sepsis or septic*) near/4 (risk*) near/4 (scor*)):ti,ab,kw

#67.

(SRS):ti,ab,kw

#68.

((sepsis* or septic*) near/4 (metascore* or meta-score*)):ti,ab,kw

#69.

MeSH descriptor: [Diagnosis, Computer-Assisted] this term only

#70.

MeSH descriptor: [Algorithms] this term only

#71.

((computer* or vital signs* or math* or manag* or clinic* or medic* or stratif* or prevent* or therap*) near/4 (algorithm*)):ti,ab,kw

#72.

(RALIS):ti,ab,kw

#73.

((computer*) near/4 (analys* or template*)):ti,ab,kw

#74.

MeSH descriptor: [Decision Support Techniques] this term only

#75.

((decision*) near/4 (aid* or analys* or support* or assist*)):ti,ab,kw

#76.

(CDSS*):ti,ab,kw

#77.

{or #59-#76}

#78.

#58 and #77

#79.

(conference):pt

#80.

((clinicaltrials or trialsearch)):so

#81.

#79 or #80

#82.

#78 not #81

DARE

1. MeSH DESCRIPTOR Infant, Newborn EXPLODE ALL TREES
2. MeSH DESCRIPTOR Term Birth
3. MeSH DESCRIPTOR Infant Care
4. MeSH DESCRIPTOR Perinatal Care
5. MeSH DESCRIPTOR Intensive Care Units, Neonatal
6. MeSH DESCRIPTOR Intensive Care, Neonatal
7. MeSH DESCRIPTOR Infant Health
8. (((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*)))
9. (((premature or pre-mature* or preterm or pre-term) NEAR4 (child* or infant* or baby* or babies* or offspring)))
10. #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9
11. MeSH DESCRIPTOR Bacterial Infections EXPLODE ALL TREE
12. (((bacter* or strep* or staph* or GNB) NEAR4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)))
13. MeSH DESCRIPTOR Sepsis EXPLODE ALL TREES
14. (((sepsis or septic?emia* or py?emia* or pyho?emia*)))
15. (((septic* NEAR4 shock*)))
16. #11 OR #12 OR #13 OR #14 OR #15
17. MeSH DESCRIPTOR Streptococcus EXPLODE ALL TREES
18. MeSH DESCRIPTOR Staphylococcus EXPLODE ALL TREES
19. (((streptococc* or staphylococc*)))
20. (((GBS or MRSA or NRCS-A or MSSA)))
21. (((met?icillin-resistant NEAR3 aureus)))
22. MeSH DESCRIPTOR Escherichia coli EXPLODE ALL TREES
23. (((Escheric* or E) NEAR2 (coli)))
24. MeSH DESCRIPTOR Listeria EXPLODE ALL TREES
25. ((listeria*))
26. MeSH DESCRIPTOR Klebsiella EXPLODE ALL TREES
27. ((klebsiella*))
28. MeSH DESCRIPTOR Pseudomonas EXPLODE ALL TREES
29. ((pseudomonas or chryseomonas or flavimonas))
30. MeSH DESCRIPTOR Enterobacteriaceae EXPLODE ALL TREES
31. (enterobact* or sodalis or paracolobactrum or ewingella or leclercia)
32. ((enteric or coliform) NEAR2 (bac*))
33. MeSH DESCRIPTOR Neisseria EXPLODE ALL TREES
34. (neisseria*)
35. MeSH DESCRIPTOR Haemophilus influenzae EXPLODE ALL TREES
36. ((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) NEAR2 (influenz* or pfeiffer* or meningitidis))
37. MeSH DESCRIPTOR Serratia EXPLODE ALL TREES
38. (serratia*)
39. MeSH DESCRIPTOR Cronobacter EXPLODE ALL TREES
40. (cronobact* or sakazaki* or malonatic*)
41. MeSH DESCRIPTOR Acinetobacter EXPLODE ALL TREES
42. ((acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*))
43. MeSH DESCRIPTOR Fusobacterium EXPLODE ALL TREES
44. ((fusobact* or sphaerophor* or necrophorum or nucleatum))
45. MeSH DESCRIPTOR Enterococcus EXPLODE ALL TREES
46. (enterococc*)
47. #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46
48. #16 OR #47
49. #10 AND #48
50. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) NEAR4 (infect*))
51. ((premature or pre-mature* or preterm or pre-term) NEAR4 (child* or infant* or baby* or babies* or offspring) NEAR4 (infect*))
52. #50 OR #51
53. #49 OR #52
54. ((bacter?emia* or bacill?emia*))
55. ((blood*) NEAR4 (infect* or contamin* or invas* or invad*))
56. #54 OR #55
57. #10 AND #56
58. #53 OR #57
59. MeSH DESCRIPTOR Risk Assessment WITH QUALIFIER MT
60. ((risk* or predict* or probab* or prognos* or quantitativ*) NEAR2 (model* or tool* or algorithm* or rul*))
61. ((diagnos*) NEAR2 (model* or algorithm*))
62. ((sepsis* or septic* or Bayes* or EOS or LOS) NEAR4 (calculator*))
63. (NEOSC or EOSCAL* or SRC)
64. ((Kaiser) NEAR2 (Permanente))
65. ((Kaiser) NEAR10 (calculator*))
66. ((sepsis or septic*) NEAR4 (risk*) NEAR4 (scor*))
67. (SRS)
68. ((sepsis* or septic*) NEAR4 (metascore* or meta-score*))
69. MeSH DESCRIPTOR Diagnosis, Computer-Assisted
70. MeSH DESCRIPTOR Algorithms
71. ((computer* or vital signs* or math* or manag* or clinic* or medic* or stratif* or prevent* or therap*) NEAR4 (algorithm*))
72. (RALIS)
73. ((computer*) NEAR4 (analys* or template*))
74. MeSH DESCRIPTOR Decision Support Techniques
75. ((decision*) NEAR4 (aid* or analys* or support* or assist*))
76. (CDSS)
77. #59 OR #60 OR #61 OR #62 OR #63 OR #64 OR #65 OR #66 OR #67 OR #68 OR #69 OR #70 OR #71 OR #72 OR #73 OR #74 OR #75 OR #76
78. #58 AND #77
79. * IN DARE
80. #78 AND #79

Population and risk factor terms

The search terms used to identify information on population and risk factors are reproduced below for all databases. The population and risk factor terms were combined as ‘And’ to identify papers that discussed both.

Medline, Medline in Process & Medline E-pub Ahead of Print

1. exp Infant, Newborn/
2. Term Birth/
3. Infant Care/
4. Perinatal Care/
5. Intensive Care Units, Neonatal/
6. Intensive Care, Neonatal/
7. Infant Health/
8. (newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*).tw.
9. ((premature* or pre-mature* or preterm* or pre-term*) adj4 (child* or infant* or baby* or babies* or offspring)).tw.
10. or/1-9
11. exp Bacterial Infections/
12. ((bacter* or strep* or staph* or GNB) adj4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)).tw.
13. exp Sepsis/
14. (sepsis or septic?emia* or py?emia* or pyho?emia*).tw.
15. (septic* adj4 shock*).tw. (
16. (bacter?emia* or bacill?emia*).tw.
17. (blood* adj4 (infect* or contamin* or invas* or invad*)).tw.
18. or/11-17
19. exp Streptococcus/
20. exp Staphylococcus/
21. (streptococc* or staphylococc*).tw.
22. (GBS or MRSA or NRCS-A or MSSA).tw.
23. (met?icillin-resistant adj3 aureus).tw.
24. exp Escherichia coli/
25. ((Escheric* or E) adj2 coli).tw.
26. exp Listeria/
27. listeria*.tw.
28. exp Klebsiella/
29. klebsiella*.tw.
30. exp Pseudomonas/
31. (pseudomonas or chryseomonas or flavimonas).tw.
32. Enterobacteriaceae/
33. (enterobact* or sodalis or paracolobactrum or ewingella or leclercia).tw.
34. ((enteric or coliform) adj2 bac*).tw.
35. exp Neisseria/
36. neisseria*.tw.
37. exp Haemophilus influenzae/
38. ((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) adj2 (influenz* or pfeiffer* or meningitidis)).tw.
39. exp Serratia/
40. serratia*.tw.
41. exp Cronobacter/
42. (cronobact* or sakazaki* or malonatic*).tw.
43. exp Acinetobacter/
44. (acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*).tw.
45. exp Fusobacterium/
46. (fusobact* or sphaerophor* or necrophorum or nucleatum).tw.
47. exp Enterococcus/
48. enterococc*.tw.
49. or/19-48
50. 18 or 49
51. 10 and 50
52. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) adj4 infect*).tw.
53. ((premature* or pre-mature* or preterm* or pre-term*) adj4 (child* or infant* or baby* or babies* or offspring) adj4 infect*).tw.
54. 52 or 53
55. 51 or 54
56. exp Fetal Membranes, Premature Rupture/
57. ((preterm* or pre-term* or premature* or pre-mature* or prelabor* or pre-labor* or pre) adj4 (ruptur* or membrane* or disrupt* or erupt* or sever or severed or tear* or breach*)).tw.
58. (prom or proms or pprom*).tw.
59. Gestational Age/
60. ((gestat* or f?etal* or f?etus*) adj4 (age* or aging* or matur*)).tw.
61. Fever/di, dg [Diagnosis, Diagnostic Imaging]
62. ((intrapartum* or intra-partum* or labo?r* or deliver* or childbirth* or child-birth* or congenit* or conatal*) adj4 (fever* or deliriu* or pyrexia* or hyperthermia*)).tw.
63. Chorioamnionitis/
64. (chorioamnionit* or amnioniti* or funisiti*).tw.
65. (parenteral* adj4 (antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or anti-mycobact* or bacteriocid*)).tw.
66. Antibiotic Prophylaxis/
67. ((antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or antimycobact* or bacteriocid*) adj4 (prophyla* or premedic* or pre-medic* or prevent*)).tw.
68. Brain Diseases/
69. ((brain* or intracranial* or intra-cranial* or encephalon*) adj4 (diseas* or disorder* or defect* or illness* or inflam* or syndrom*)).tw.
70. encephalopath*.tw.
71. Persistent Fetal Circulation Syndrome/
72. ((persist* or misalign* or mis-align*) adj4 (f?etal* or f?etus* or pulmonar*) adj4 (circulat* or hypertens* or vein*)).tw.
73. (PPHN or PFC or ACD MPV or ACDMPV).tw.
74. or/56-73
75. 55 and 74
76. Animals/ not Humans/
77. 75 not 76
78. limit 77 to english language

Embase

1. newborn/
2. term birth/
3. infant care/
4. perinatal care/
5. neonatal intensive care unit/
6. newborn intensive care/
7. child health/
8. (newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*).tw.
9. ((premature* or pre-mature* or preterm* or pre-term*) adj4 (child* or infant* or baby* or babies* or offspring)).tw.
10. or/1-9
11. exp bacterial infection/
12. ((bacter* or strep* or staph* or GNB) adj4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)).tw.
13. exp sepsis/
14. (sepsis or septic?emia* or py?emia* or pyho?emia*).tw.
15. (septic* adj4 shock*).tw.
16. (bacter?emia* or bacill?emia*).tw.
17. (blood* adj4 (infect* or contamin* or invas* or invad*)).tw.
18. or/11-17
19. exp Streptococcus/
20. exp Staphylococcus/
21. (streptococc* or staphylococc*).tw.
22. (GBS or MRSA or NRCS-A or MSSA).tw.
23. (met?icillin-resistant adj3 aureus).tw.
24. exp Escherichia coli/
25. ((Escheric* or E) adj2 coli).tw.
26. exp Listeria/
27. listeria*.tw.
28. exp Klebsiella/
29. klebsiella*.tw.
30. exp Pseudomonas/
31. (pseudomonas or chryseomonas or flavimonas).tw.
32. Enterobacteriaceae/
33. (enterobact* or sodalis or paracolobactrum or ewingella or leclercia).tw.
34. ((enteric or coliform) adj2 bac*).tw.
35. exp Neisseria/
36. neisseria*.tw.
37. exp Haemophilus influenzae/
38. ((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) adj2 (influenz* or pfeiffer* or meningitidis)).tw.
39. exp Serratia/
40. serratia*.tw.
41. exp cronobacter/
42. (cronobact* or sakazaki* or malonatic*).tw.
43. exp Acinetobacter/
44. (acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*).tw.
45. exp Fusobacterium/
46. (fusobact* or sphaerophor* or necrophorum or nucleatum).tw.
47. exp Enterococcus/
48. enterococc*.tw.
49. or/19-48
50. 18 or 49
51. 10 and 50
52. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) adj4 infect*).tw.
53. ((premature* or pre-mature* or preterm* or pre-term*) adj4 (child* or infant* or baby* or babies* or offspring) adj4 infect*).tw.
54. 52 or 53
55. 51 or 54
56. exp premature fetus membrane rupture/
57. ((preterm* or pre-term* or premature* or pre-mature* or prelabor* or pre-labor* or pre) adj4 (ruptur* or membrane* or disrupt* or erupt* or sever or severed or tear* or breach*)).tw.
58. (prom or proms or pprom*).tw.
59. gestational age/
60. ((gestat* or f?etal* or f?etus*) adj4 (age* or aging* or matur*)).tw.
61. fever/di [Diagnosis]
62. ((intrapartum* or intra-partum* or labo?r* or deliver* or childbirth* or child-birth* or congenit* or conatal*) adj4 (fever* or deliriu* or pyrexia* or hyperthermia*)).tw.
63. exp chorioamnionitis/
64. (chorioamnionit* or amnioniti* or funisiti*).tw.
65. (parenteral* adj4 (antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or anti-mycobact* or bacteriocid*)).tw.
66. antibiotic prophylaxis/
67. ((antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or antimycobact* or bacteriocid*) adj4 (prophyla* or premedic* or pre-medic* or prevent*)).tw.
68. brain disease/
69. ((brain* or intracranial* or intra-cranial* or encephalon*) adj4 (diseas* or disorder* or defect* or illness* or inflam* or syndrom*)).tw.
70. encephalopath*.tw.
71. persistent pulmonary hypertension/
72. ((persist* or misalign* or mis-align*) adj4 (f?etal* or f?etus* or pulmonar*) adj4 (circulat* or hypertens* or vein*)).tw.
73. (PPHN or PFC or ACD MPV or ACDMPV).tw.
74. or/56-73
75. 55 and 74
76. nonhuman/ not human/
77. 75 not 76
78. limit 77 to english language

CDSR

#1.

MeSH descriptor: [Infant, Newborn] explode all trees

#2.

MeSH descriptor: [Term Birth] this term only

#3.

MeSH descriptor: [Infant Care] this term only

#4.

MeSH descriptor: [Perinatal Care] this term only

#5.

MeSH descriptor: [Intensive Care Units, Neonatal] this term only

#6.

MeSH descriptor: [Intensive Care, Neonatal] this term only

#7.

MeSH descriptor: [Infant Health] this term only

#8.

((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*)):ti,ab,kw

#9.

((premature* or pre-mature* or preterm* or pre-term*) near/4 (child* or infant* or baby* or babies* or offspring)):ti,ab,kw

#10.

{or #1-#9}

#11.

MeSH descriptor: [Bacterial Infections] explode all trees

#12.

((bacter* or strep* or staph* or GNB) near/4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)):ti,ab,kw

#13.

MeSH descriptor: [Sepsis] explode all trees

#14.

(sepsis or septic?emia* or py?emia* or pyho?emia*):ti,ab,kw

#15.

(septic* near/4 shock*):ti,ab,kw

#16.

(bacter?emia* or bacill?emia*):ti,ab,kw

#17.

((blood*) near/4 (infect* or contamin* or invas* or invad*)):ti,ab,kw

#18.

{or #11-#17}

#19.

MeSH descriptor: [Streptococcus] explode all trees

#20.

MeSH descriptor: [Staphylococcus] explode all trees

#21.

(streptococc* or staphylococc*):ti,ab,kw

#22.

(GBS or MRSA or NRCS-A or MSSA):ti,ab,kw

#23.

(met?icillin-resistant near/3 aureus):ti,ab,kw

#24.

MeSH descriptor: [Escherichia coli] explode all trees

#25.

((Escheric* or E) near/2 (coli)):ti,ab,kw

#26.

MeSH descriptor: [Listeria] explode all trees

#27.

(listeria*):ti,ab,kw

#28.

MeSH descriptor: [Klebsiella] explode all trees

#29.

(klebsiella*):ti,ab,kw

#30.

MeSH descriptor: [Pseudomonas] explode all trees

#31.

(pseudomonas or chryseomonas or flavimonas):ti,ab,kw

#32.

MeSH descriptor: [Enterobacteriaceae] explode all trees

#33.

(enterobact* or sodalis or paracolobactrum or ewingella or leclercia):ti,ab,kw

#34.

((enteric or coliform) near/2 (bac*)):ti,ab,kw

#35.

MeSH descriptor: [Neisseria] explode all trees

#36.

(neisseria*):ti,ab,kw

#37.

MeSH descriptor: [Haemophilus influenzae] explode all trees

#38.

((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) near/2 (influenz* or pfeiffer* or meningitidis)):ti,ab,kw

#39.

MeSH descriptor: [Serratia] explode all trees

#40.

(serratia*):ti,ab,kw

#41.

MeSH descriptor: [Cronobacter] explode all trees

#42.

(cronobact* or sakazaki* or malonatic*):ti,ab,kw

#43.

MeSH descriptor: [Acinetobacter] explode all trees

#44.

(acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*):ti,ab,kw

#45.

MeSH descriptor: [Fusobacterium] explode all trees

#46.

(fusobact* or sphaerophor* or necrophorum or nucleatum):ti,ab,kw 296

#47.

MeSH descriptor: [Enterococcus] explode all trees

#48.

(enterococc*):ti,ab,kw

#49.

{or #19-#48}

#50.

#18 or #49

#51.

#10 and #50

#52.

((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) near/4 (infect*)):ti,ab,kw

#53.

((premature* or pre-mature* or “preterm*” or “pre-term*”) near/4 (child* or infant* or baby* or babies* or offspring) near/4 (infect*)):ti,ab,kw

#54.

#52 or #53

#55.

#51 or #54

#56.

MeSH descriptor: [Fetal Membranes, Premature Rupture] explode all trees

#57.

((preterm* or pre-term* or premature* or pre-mature* or prelabor* or pre-labor* or pre) near/4 (ruptur* or membrane* or disrupt* or erupt* or sever or severed or tear* or breach*)):ti,ab,kw

#58.

(prom or proms or pprom*):ti,ab,kw

#59.

MeSH descriptor: [Gestational Age] this term only

#60.

((gestat* or f?etal* or f?etus*) near/4 (age* or aging* or matur*)):ti,ab,kw

#61.

MeSH descriptor: [Fever] this term only and with qualifier(s): [diagnostic imaging - DG, diagnosis - DI]

#62.

((intrapartum* or intra-partum* or labo?r* or deliver* or childbirth* or child-birth* or congenit* or conatal*) near/4 (fever* or deliriu* or pyrexia* or hyperthermia*)):ti,ab,kw

#63.

MeSH descriptor: [Chorioamnionitis] this term only

#64.

(chorioamnionit* or amnioniti* or funisiti*):ti,ab,kw

#65.

((parenteral*) near/4 (antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or anti-mycobact* or bacteriocid*)):ti,ab,kw

#66.

MeSH descriptor: [Antibiotic Prophylaxis] this term only

#67.

((antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or antimycobact* or bacteriocid*) near/4 (prophyla* or premedic* or pre-medic* or prevent*)):ti,ab,kw

#68.

MeSH descriptor: [Brain Diseases] this term only

#69.

((brain* or intracranial* or intra-cranial* or encephalon*) near/4 (diseas* or disorder* or defect* or illness* or inflam* or syndrom*)):ti,ab,kw

#70.

(encephalopath*):ti,ab,kw

#71.

MeSH descriptor: [Persistent Fetal Circulation Syndrome] this term only

#72.

((persist* or misalign* or mis-align*) near/4 (f?etal* or f?etus* or pulmonar*) near/4 (circulat* or hypertens* or vein*)):ti,ab,kw

#73.

(PPHN or PFC or ACD MPV or ACDMPV):ti,ab,kw

#74.

{or #56-#73}

#75.

#55 and #74

DARE

1. MeSH DESCRIPTOR Infant, Newborn EXPLODE ALL TREES
2. MeSH DESCRIPTOR Term Birth
3. MeSH DESCRIPTOR Infant Care
4. MeSH DESCRIPTOR Perinatal Care
5. MeSH DESCRIPTOR Intensive Care Units, Neonatal
6. MeSH DESCRIPTOR Intensive Care, Neonatal
7. MeSH DESCRIPTOR Infant Health
8. (newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*)
9. ((premature or pre-mature* or preterm or pre-term) NEAR4 (child* or infant* or baby* or babies* or offspring))
10. (#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9)
11. MeSH DESCRIPTOR Bacterial Infections EXPLODE ALL TREES
12. ((bacter* or strep* or staph* or GNB) NEAR4 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*))
13. MeSH DESCRIPTOR Sepsis EXPLODE ALL TREES
14. (sepsis or septic?emia* or py?emia* or pyho?emia*)
15. ((septic* NEAR4 shock*))
16. (bacter?emia* or bacill?emia*)
17. ((blood*) NEAR4 (infect* or contamin* or invas* or invad*))
18. (#11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17)
19. MeSH DESCRIPTOR Streptococcus EXPLODE ALL TREES
20. MeSH DESCRIPTOR Staphylococcus EXPLODE ALL TREES
21. (streptococc* or staphylococc*)
22. (GBS or MRSA or NRCS-A or MSSA)
23. ((met?icillin-resistant NEAR3 aureus))
24. MeSH DESCRIPTOR Escherichia coli EXPLODE ALL TREES
25. ((Escheric* or E) NEAR2 (coli))
26. MeSH DESCRIPTOR listeria EXPLODE ALL TREES
27. (listeria*)
28. MeSH DESCRIPTOR Klebsiella EXPLODE ALL TREES
29. (klebsiella*)
30. MeSH DESCRIPTOR Pseudomonas EXPLODE ALL TREES
31. (pseudomonas or chryseomonas or flavimonas)
32. MeSH DESCRIPTOR Enterobacteriaceae EXPLODE ALL TREES
33. (enterobact* or sodalis or paracolobactrum or ewingella or leclercia)
34. ((enteric or coliform) NEAR2 (bac*))
35. MeSH DESCRIPTOR Neisseria EXPLODE ALL TREES
36. (neisseria*)
37. MeSH DESCRIPTOR Haemophilus influenzae EXPLODE ALL TREES
38. ((h?emophil* or H or bacter* or bacill* or mycobacter* or coccobac*) NEAR2 (influenz* or pfeiffer* or meningitidis))
39. MeSH DESCRIPTOR Serratia EXPLODE ALL TREES
40. (serratia*)
41. MeSH DESCRIPTOR Cronobacter EXPLODE ALL TREES
42. (cronobact* or sakazaki* or malonatic*)
43. MeSH DESCRIPTOR Acinetobacter EXPLODE ALL TREES
44. (acinetobact* or herellea* or mima or baumanni* or genomosp* or calcoacetic*)
45. MeSH DESCRIPTOR Fusobacterium EXPLODE ALL TREES
46. (fusobact* or sphaerophor* or necrophorum or nucleatum)
47. MeSH DESCRIPTOR Enterococcus EXPLODE ALL TREES
48. (enterococc*)
49. (#19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46 OR #47 OR #48)
50. (#18 OR #49)
51. (#10 AND #50)
52. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) NEAR4 (infect*))
53. ((premature or pre-mature* or preterm or pre-term) NEAR4 (child* or infant* or baby* or babies* or offspring) NEAR4 (infect*))
54. (#52 OR #53)
55. (#51 OR #54)
56. MeSH DESCRIPTOR Fetal Membranes, Premature Rupture EXPLODE ALL TREES
57. ((preterm* or pre-term* or premature* or pre-mature* or prelabor* or pre-labor* or pre) NEAR4 (ruptur* or membrane* or disrupt* or erupt* or sever or severed or tear* or breach*))
58. (prom or proms or pprom*)
59. MeSH DESCRIPTOR Gestational Age
60. ((gestat* or f?etal* or f?etus*) NEAR4 (age* or aging* or matur*))
61. MeSH DESCRIPTOR Fever WITH QUALIFIER DI
62. MeSH DESCRIPTOR Fever WITH QUALIFIER DG
63. ((intrapartum* or intra-partum* or labo?r* or deliver* or childbirth* or child-birth* or congenit* or conatal*) NEAR4 (fever* or deliriu* or pyrexia* or hyperthermia*))
64. MeSH DESCRIPTOR Chorioamnionitis
65. (chorioamnionit* or amnioniti* or funisiti*)
66. ((parenteral*) NEAR4 (antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or anti-mycobact* or bacteriocid*))
67. MeSH DESCRIPTOR Antibiotic Prophylaxis
68. ((antibacter* or anti-bacter* or antibiotic* or anti-biotic* or antimycobact* or antimycobact* or bacteriocid*) NEAR4 (prophyla* or premedic* or pre-medic* or prevent*))
69. MeSH DESCRIPTOR Brain Diseases
70. ((brain* or intracranial* or intra-cranial* or encephalon*) NEAR4 (diseas* or disorder* or defect* or illness* or inflam* or syndrom*))
71. (encephalopath*)
72. MeSH DESCRIPTOR Persistent Fetal Circulation Syndrome
73. ((persist* or misalign* or mis-align*) NEAR4 (f?etal* or f?etus* or pulmonar*) NEAR4 (circulat* or hypertens* or vein*))
74. (PPHN or PFC or ACD MPV or ACDMPV)
75. #56 OR #57 OR #58 OR #59 OR #60 OR #61 OR #62 OR #63 OR #64 OR #65 OR #66 OR #67 OR #68 OR #69 OR #70 OR #71 OR #72 OR #73 OR #74
76. #55 AND #75
77. * IN DARE
78. #76 AND #77

Search Filters

The following search filters were combined as ‘And’ with the population and risk factor terms for the Medline databases and Embase. CDSR and DARE are systematic review databases so did not require the addition of a filter.

The Medline versions of the filters are reproduced below. Embase has validated translations of these that were used in the search.

Systematic Review

1. MEDLINE or pubmed).tw.
2. systematic review.tw.
3. systematic review.pt.
4. meta-analysis.pt.
5. intervention$.ti.
6. or/1-5

Observational studies

The in-house observational studies filter was adapted to focus on cross-sectional studies this was then supplemented with the McMaster diagnostic and prognostic filters.

1. Cohort Studies/
2. Prospective Studies/
3. Retrospective Studies/
4. Cross-Sectional Studies/
5. cohort:.mp.
6. predictor:.tw.
7. cross sectional.tw.
8. prospective*.tw.
9. retrospective*.tw.
10. sensitiv:.mp.
11. predictive value:.mp.
12. accurac:.tw.
13. prognosis.sh.
14. diagnosed.tw.
15. death.tw.
16. exp models, statistical/
17. or/1-16

Risk terms

Following combination of population, risk factor and filter terms (if an appropriate database) the number of results were still considered too high. Additional risk terms were combined as ‘And’ with the other sections of the search strategy to reduce numbers.

The Medline risk terms are listed below. These were translated across all databases used in the search:

1. exp Risk/
2. exp Risk Management/
3. Pregnancy, High Risk/
4. risk*.tw.
5. exp Health Status Indicators/
6. ((health* or illness* or wellness* or wellbeing* or well-being*) adj4 (indicat* or index* or indices* or apprais* or barometer* or gaug* or mark* or warn* or ratio or ratios)).tw.
7. (sever* adj4 illness*).tw.
8. exp “Signs and Symptoms”/
9. ((symptom* or sign or signs or manifest* or phenomenon*) adj8 (infect* or diseas* or contaminat* or mening* or pneumon* or nosocomial*)).tw.
10. or/1-9

Virus terms

The following terms were combined as ‘Not’ with the other sections of the search strategy to remove any papers focused on viral illness.

The Medline virus terms are listed below. These were translated across all databases used in the search:

1. exp Virus Diseases/
2. exp Viruses/
3. (virus* or viral* or retrovir* or arbovir* or lentivir* or deltaretrovir* or adenovir*).tw.
4. HIV*.tw.
5. (cytomegalovir* or CMV*).tw.
6. herpes*.tw.
7. (papillomavir* or HPV*).tw.
8. ((hepatitis* or hepatitid*) adj2 (A or B or C or D or E)).tw.
9. (parechovir* or echovir*).tw.
10. (yellow* adj2 fever*).tw.
11. rhinovir*.tw.
12. (coronavir* or deltacoronavir*).tw.
13. rotavir*.tw.
14. (enterovir* or coxsackie*).tw.
15. exp Malaria/
16. (malaria* or paludism*).tw.
17. exp Syphilis/
18. (syphili* or neurosyphili* or neuro-syphili*).tw.
19. or/1-18

Risk factors included in the search for review questions 5.1 and 5.2

The risk factors searched for as part of review questions 5.1 and 5.2 were considered for this evidence review and results from that search considered as part of the analysis. As a result of this they were removed from this search. This was to ensure there was no duplication of effort and there was a unique set of results for this search.

The following risk factors were combined as ‘Not’ with the other sections of the search strategy. The Medline risk factor terms are listed below. These were translated across all databases used in the search:

1. ((previous or preceding or earlier or prior or antecedent) adj4 (child* or infant* or baby* or babies* or offspring or delivery or deliveries)).tw.
2. ((later or next or succeeding) adj4 (child* or infant* or baby* or babies* or offspring or delivery or deliveries)).tw.
3. (Infectious Disease Transmission, Vertical/ or Carrier State/) and (Streptococcal Infections/ or Methicillin-Resistant Staphylococcus aureus/)
4. ((vertical* or maternal* or mother* or mum* or mom* or parental* or fetomaternal* or fetomaternal* or woman* or women* or pregnan* or gestat* or parturition* or birth* or childbirth* or labo?r*) adj4 (GBS* or group B* or MRSA* or met?icillin-resist*) adj4 (transmission* or transmit* or transfer* or infect* or diseas* or contaminat* or coloni?ation* or contagio* or bacteriuria* or carrier* or carriage or heterozygo*)).tw.
5. exp Pregnancy, Multiple/
6. ((multiple or twin or triplet or quadruplet or quintuplet or superfetation) adj4 (pregnan* or gestat* or parturition* or birth* or childbirth* or labo?r* or delivery or deliveries)).tw.
7. Wound Infection/
8. (wound* adj4 (infect* or diseas* or contaminat* or coloni?ation* or contagio* or sepsis)).tw.
9. Postpartum Period/
10. (postpartum or post-partum or puerperium or puerperal).tw.
11. ((perineal or perineum) adj4 (infect* or diseas* or contaminat* or coloni?ation* or contagio*)).tw.
12. exp Obesity/
13. ((obesity or obese or overweight or over-weight) adj8 risk*).tw.
14. exp Hygiene/
15. exp Sanitation/
16. (hygien* or saniti?e* or sanitation* or sanitary*).tw.
17. exp Maternal Behavior/
18. ((behavio?r* or attitud*) adj4 (factor* or aspect* or consider* or circumstanc* or component* or influenc* or feature*)).tw.
19. Illness Behavior/
20. ((alter* or chang* or illness*) adj4 (behavio?r* or respons* or feedback*) adj8 risk*).tw.
21. Muscle Hypotonia/
22. (flop* or flaccid* or hypoton* or hypomyotoni*).tw.
23. ((alter* or chang* or poor* or decreas* or atonic* or feeble or insuffic* or meag* or weak* or unsatisfact* or imperfect* or impair* or declin* or reduc* or diminish*) adj4 musc*).tw.
24. Feeding Behavior/
25. ((feed* or bottle* or breast*) adj4 (behavio?r* or difficult* or refus* or intoleran* or declin* or ignor* or withdraw* or problem*)).tw.
26. exp Vomiting/
27. (vomit* or emesis*).tw.
28. ((gastric* or nasogastric* or naso-gastric*) adj4 (aspirat* or suction*)).tw.
29. (abdom?n* adj4 disten*).tw.
30. Arrhythmias, Cardiac/ or Atrial Fibrillation/ or Atrial Flutter/ or Cardiac Complexes, Premature/ or Parasystole/ or Ventricular Fibrillation/ or Ventricular Flutter/
31. (arr?ythmia* or dysrhythmia*).tw.
32. ((abnormal* or anomal* or atypical* or irregular* or uncommon* or unexpect*) adj4 (heart* or cardiac* or vascular*) adj2 (rate* or pace* or measure* or rhythm* or beat*)).tw.
33. Bradycardia/ or Tachycardia/
34. (bradycardia* or bradyarrhythmia* or tachycardia* or tachyarrhythmia*).tw.
35. Respiratory Distress Syndrome, Newborn/
36. ((respirat* or breath*) adj4 (distres* or troubl* or discomfort*)).tw.
37. exp Hypoxia/
38. (hypoxia* or hypoxic* or hypoxem* or anoxia* or anoxem*).tw.
39. (oxygen* adj4 (deficien* or reduc* or suturat* or concentrat* or measur*)).tw.
40. exp Cyanosis/
41. exp Oximetry/
42. (cyanos?s* or cyanotic* or oximet*).tw.
43. exp Jaundice, Neonatal/
44. (jaundice* or icterus*).tw.
45. exp Apnea/
46. apn?ea*.tw.
47. Seizures/
48. ((seizure* or convuls* or paroxysm*) adj8 risk*).tw.
49. exp Cardiopulmonary Resuscitation/
50. (((cardiopulmon* or cardio-pulmon* or mouth-to-mouth*) adj4 resuscitat*) or CPR).tw.
51. exp Respiration, Artificial/
52. ((artificial* or mechanic* or automat* or machine* or control*) adj4 (respirat* or ventilat* or breath* or oxygenat*)).tw.
53. exp Body Temperature/
54. ((body* or organ* or skin* or high* or low* or excess* or reduc*) adj4 temperat*).tw.
55. ((“36*” or “38*”) adj2 (C or celsius)).tw.
56. ((“96*” or “100*”) adj2 (F or fahrenheit)).tw.
57. exp Shock/
58. (shock not (septic or sepsis)).tw.
59. (circulat* adj4 (collaps* or fail*)).tw.
60. ((pale* or cold* or clammy or chill* or blanch*) adj4 skin*).tw.
61. Sweat/ or Sweating/
62. (sweat* or perspir*).tw.
63. ((rapid* or shallow* or accelarat* or hollow* or flat*) adj4 (breath* or respirat*)).tw.
64. (weakness* or fragilit*).tw.
65. Dizziness/
66. (dizz* or orthostas* or lighthead* or light-head*).tw.
67. Thirst/
68. thirst*.tw.
69. Yawning/
70. (yawn* or sigh or sighs).tw.
71. exp Hemorrhage/
72. (bleed* or h?emorrhag*).tw.
73. (blood* adj4 (loss or effus* or excess*)).tw.
74. exp Thrombocytopenia/
75. (thrombocytop?enia* or thrombop?enia*).tw.
76. Blood Coagulation/
77. ((coagulat* or clot or clott*) adj8 risk*).tw.
78. Oliguria/
79. oliguria*.tw.
80. ((decreas* or diminish* or dwindl* or reduc* or wane) adj4 urin*).tw.
81. Homeostasis/
82. (homeostas* or homeostat* or autoregulat* or auto-regulat*).tw.
83. exp Hypoglycemia/
84. exp Hyperglycemia/
85. (hypoglyc?emi* or hyperglyc?emi*).tw.
86. ((low* or high*) adj4 blood* adj4 (sugar* or glucose*)).tw.
87. exp Acidosis/
88. acidos?s*.tw.
89. ((local* or region* or limit*) adj4 (infect* or contamin* or invas*)).tw.
90. ((previous* or preced* or earlier or prior* or anteceden* or histor* or past*) adj4 (surg* or operat*)).tw.
91. exp Catheters/ or Catheterization/ or Catheterization, Central Venous/ or exp Catheterization, Peripheral/
92. ((catheter* or cannula*) adj4 (present* or presence* or exist* or attend* or current*)).tw.
93. ((indwell* or in-dwell*) adj4 (devic* or apparat* or applianc* or equip* or gadget* or machine* or mechanism*)).tw.
94. (prematur* adj8 risk*).tw.
95. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat*) adj4 (admiss* or admit*)).tw.
96. ((previous* or preced* or earlier or prior* or anteceden* or histor* or past*) adj4 (GBS* or group B*) adj4 (infect* or contamin* or invas*)).tw.
97. ((newborn* or new born* or neonat* or neo-nat* or perinat* or peri-nat* or infant* or baby* or babies*) adj4 (GBS* or group B* or MRSA* or met?icillin-resist*) adj4 (contaminat* or coloni?ation* or contagio*)).tw.
98. or/1-97