Base excess shows 85.8% sensitivity and 82.9% specificity for neonatal sepsis diagnosis in meta-analysisBase Excess Levels May Help Identify Neonatal Sepsis Risk

Journal of neonatal-perinatal medicine Published July 4, 2026 Study authors: Mangkuliguna Ghea, Romli Muhammad Ifan, Adrianto Nicholas PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider BE as a potential adjunctive biomarker for neonatal sepsis, but interpret with caution due to low-certainty evidence.

This meta-analysis assessed the diagnostic and prognostic utility of base excess (BE) in neonates with sepsis. The analysis included studies evaluating BE thresholds for diagnosis and mortality prediction. At a BE threshold of ≤-5 mEq/L, pooled sensitivity was 85.8% (95% CI: 59.9%-96.1%) and specificity 82.9% (95% CI: 46.2%-96.5%), with an AUC of 0.909. For cord blood BE ≤-10 mEq/L, specificity was high at 96.7% (95% CI: 91.5%-98.8%) but sensitivity was only 10.3% (95% CI: 6.5%-15.7%). Decreased BE levels were associated with increased mortality risk (OR 3.14; 95% CI: 1.34-7.36).

The authors noted that the evidence certainty was low according to GRADE methodology, limiting the strength of recommendations. Limitations included low-certainty evidence and the need for further prospective validation. The review did not report sample size, setting, follow-up, or adverse events.

Practice relevance: BE shows potential as a biomarker for neonatal sepsis diagnosis and mortality risk stratification, but clinicians should interpret these findings cautiously given the low-certainty evidence. Further prospective studies are needed before routine clinical use.

How this fits prior evidence

This meta-analysis extends prior findings on neonatal sepsis biomarkers. While IL-27 was found superior to CRP for diagnosis, BE offers a readily available alternative with moderate sensitivity and specificity. The mortality association (OR 3.14) adds prognostic value beyond diagnostic markers. However, the low-certainty evidence contrasts with the stronger evidence supporting 7-day antibiotic regimens and AMR strategies in LMIC newborns.

Researchers analyzed the use of base excess (BE) as a tool to help identify and predict outcomes for infants with neonatal sepsis. This type of measurement looks at the acid-base balance in the blood. The study looked at how specific BE levels could act as markers for the condition.

The analysis found that certain low base excess levels were linked to an increased risk of mortality in these patients. Specifically, a threshold of -5 mEq/L showed high sensitivity and specificity for identifying the condition. However, another measurement taken from cord blood showed very high specificity but much lower sensitivity.

It is important to note that the evidence for this finding is currently of low certainty. While base excess shows potential as a biomarker, it is not yet a standard clinical tool. More large-scale studies are needed to confirm these findings before they can be used routinely in hospitals.

What this means for you:

Base excess levels may help identify neonatal sepsis, but more research is needed to confirm its use.

Common questions

What is base excess and how does it relate to sepsis?

Base excess (BE) is a measure of the acid-base balance in the blood. This study looked at whether low BE levels could help identify neonatal sepsis and predict mortality risks. A threshold of -5 mEq/L showed high sensitivity and specificity, while cord blood measurements showed different results.

Can base excess be used to predict mortality in infants?

The study found a link between decreased base excess levels and an increased risk of mortality. Specifically, the data showed an odds ratio of 3.14 for those with lower levels. However, because the evidence certainty is currently low, it is not yet a standard tool.

Is this finding enough to change how doctors treat sepsis?

Not yet. While the study shows that base excess has potential as a biomarker for neonatal sepsis, researchers state that it requires further prospective validation. You should always consult with medical professionals regarding specific treatment plans and diagnostic tools.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJul 2026

PMID41199616

View Original Abstract ↓

Sepsis remains a significant cause of neonatal mortality and morbidity. Early diagnosis remains challenging due to nonspecific clinical presentation and limitations of current diagnostic approaches. Base excess (BE), derived from routine blood gas analysis, has emerged as a potential rapid biomarker reflecting metabolic disturbances associated with sepsis. We aim to evaluate the diagnostic and prognostic utility of BE in neonatal sepsis. A literature search was conducted across PubMed/MedLine, Scopus, Cochrane Library, EBSCOHost, and gray literature repositories from inception to July 2025. We included studies reporting BE measurement in neonatal sepsis. Two-by-two data were pooled using bivariate random-effects models to estimate sensitivity, specificity, and area under the curve (AUC). Mortality risk was assessed using odds ratios. This study followed the PRISMA guideline, and evidence certainty was evaluated using the GRADE methodology. The protocol has been registered in the PROSPERO (CRD42024601108). Six studies were included in this meta-analysis. BE threshold ≤-5 mEq/L from arterial/capillary blood demonstrated a pooled sensitivity of 85.8% (95% CI: 59.9%-96.1%), a specificity of 82.9% (95% CI: 46.2%-96.5%), and an AUC of 0.909. Cord blood BE ≤ -10 mEq/L showed high specificity (96.7%, 95% CI: 91.5%-98.8%) but low sensitivity (10.3%, 95% CI: 6.5%-15.7%). Decreased BE levels were associated with increased mortality risk (OR 3.14; 95% CI: 1.34-7.36). The certainty of evidence was low. BE shows potential as a biomarker for neonatal sepsis. However, the low-certainty evidence underscores the need for further prospective validation and exploration of BE's role within combined biomarker algorithms before widespread clinical implementation.

Base excess shows 85.8% sensitivity and 82.9% specificity for neonatal sepsis diagnosis in meta-analysisBase Excess Levels May Help Identify Neonatal Sepsis Risk

How this fits prior evidence

Common questions

Study Details

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Base excess shows 85.8% sensitivity and 82.9% specificity for neonatal sepsis diagnosis in meta-analysisBase Excess Levels May Help Identify Neonatal Sepsis Risk

How this fits prior evidence

Common questions

More on Neonatal Sepsis

Study Details

Intraosseous route for out-of-hospital cardiac arrest linked to lower outcomes than intravenous access

Using a bone needle instead of a vein line lowers survival chances for cardiac arrest patients

Clinical research that matters. Delivered to your inbox.

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