23 Another study, by Sankar et al.,24 in which the hematological score was analyzed, including total leukocytes, total neutrophils, immature neutrophil fraction, and CRP, demonstrated a sensitivity of 93% to 100% and specificity of 83% in the presence of two abnormal parameters for neonates with suspected sepsis. CRP has also been considered useful for the monitoring of neonates with signs of sepsis due to high NPV marker. The decrease in this marker, together with clinical improvement, has been used as a parameter

for the discontinuation of antibiotic therapy.18 A prospective study performed for over three years in a NICU in Rio de Janeiro showed altered leukogram results in 64.3% of cases of probable sepsis with appropriate compatible picture, and the C‐reactive protein (CRP) measurement

was elevated in patients with Dolutegravir proven sepsis.17 In the present study, the correlation between national criteria regarding NHSN for HAI reporting and sepsis in newborns was considered high (kappa = 96.9% and 97.3%, respectively). However, the HAI notifications that showed the biggest difference between the methods were of clinical sepsis. It is noteworthy that the notification of clinical sepsis is still recommended by ANVISA,8 although it has been excluded from the NHSN7 protocol version from July 2011, when data KRX-0401 datasheet collection for this study had already been finished. All 25 reports of clinical sepsis that did not meet the ANVISA criteria and thus were solely Pyruvate dehydrogenase reported based on NHSN criteria occurred due to the requirement of a larger number of parameters, including the need for laboratory abnormalities: Complete Blood Count (CBC) with three or more abnormal parameters and/or altered CRP measurement, which may contribute to obtain a more reliable notification. ANVISA also adds a larger number of clinical signs for the reporting of clinical sepsis, such as food intolerance, hemodynamic instability, worsening of breathing,

glucose intolerance, and lethargy.8 The proposal made by ANVISA8 is close to the current clinical management and literature,18, 23 and 24 which tend to consider laboratory findings for the diagnosis of sepsis and the start or maintenance of antibiotic therapy. In a study previously performed in the same service, which exclusively used the national criteria for the reporting of infections in neonatology, it was observed that the main indicators of HAIs and topographies were similar to other previous studies based on the international NHSN criteria.25 In a study conducted for two years in the NICU of Hospital Universitário do Rio de Janeiro, the national HAI criteria8 were employed, aiming to improve the diagnosis and reporting of sepsis in low‐birth weight neonates.