Assessing the Role of Clinical Manifestations and Laboratory Findings in Neonatal Sepsis

Abstract

Background: Neonatal sepsis is one of the major causes of morbidity and mortality in newborns. Since early diagnosis of neonatal septicemia is important for timely initiation of correct antimicrobial therapy and considering the existence of variability in nonspecific clinical laboratories, we assessed the role of clinical manifestations and laboratory findings to find the right diagnosis. Objectives: The aim of this study was to evaluate, record and rank the clinical manifestations and lab data of neonates with clinical sepsis. Methods: In a cross sectional descriptive prospective study in 2013, a total of 110 consecutive infants with clinical manifestations of sepsis were studied in two groups including early onset sepsis (EOS) taking place at 72 hours of age or younger, and late onset sepsis (LOS) occurring after 72 hours. Check list of infant's data, presenting symptoms or signs and laboratory data in both groups were evaluated and recorded. Significant differences were set at as P < 0.05. Results: Overall, 81.8% of infants had EOS while 18.2% of infants had LOS. The mean age at the time of EOS and LOS presentation was one to two days and four to twelve days, respectively. The most common clinical manifestations were respiratory distress in 49 (44.5%), jaundice in 28 (25.5%), vomiting in 26 (23.6%) and poor feeding in 23 (20.9%) of the infants. Other clinical manifestations were lethargy (weakness), decreased sucking reflex, fever, tremor, abdominal distention and seizure, found in 12 (10.9%), 10 (9.1%), 4 (3.6%), 4 (3.6%), 3 (2.7%) and 2 (1.8%) neonates, respectively. Early Onset Sepsis was considerably associated with respiratory distress (P < 0.001), while LOS in neonates was followed by jaundice (P < 0.001), seizure (P = 0.02) and fever (P < 0.001). Anemia, leukocytopenia, leukocytosis, thrombocytopenia and C-reactive protein (CRP) positive results and blood culture was detected in 36 (32.7%), 2 (1.8%), 0 (0%), 2 (1.8%), 19 (17.3%) and 110 (100 %) neonates, respectively. Cerebrospinal Fluid (CSF) cultures were negative in all infants. Positive urine culture was seen in 10 (9.1%) infants. Conclusions: Respiratory distress is more common in EOS whereas jaundice, fever and seizure are more likely to be observed in LOS infants. Considering the results, clinical manifestations should be regarded as an important part of early diagnosis of sepsis.

Nosocomial Infection Surveillance in Neonatal Intensive Care Units of Bahrami Children’s Hospital

“…Although clinical manifestations were frequently subtle and nonspecific, they can be helpful in the early detection of NIs. Respiratory distress, poor feeding, and fever were the most common presentations of NIs in neonates, which was in line with other studies (21,22). In our study, 58.3% of the neonates had positive cultures.…”

Comparison of Mean Platelet Counts in Preterm Infants with and without Retinopathy of Prematurity

“…The change in mean platelet counts after adjustment may be attributed to the effect of the confounding factors (volume of blood transfusion, sepsis and presence of bronchopulmonary dysplasia) on ROP [ 24 , 25 , 26 , 27 ]. Sepsis is commonly known to be related to thrombocytopenia.…”

“…Sepsis not only causes endothelial damage with resultant increased platelet activation, initiating a vicious cycle of subsequent platelet-mediated cytotoxic endothelium damage [ 28 ], but also causes bone marrow suppression, with consequent decreased platelet production [ 29 ]. A meta-analysis investigating the association between sepsis and ROP found that sepsis increases the risk of ROP [ 26 ]. This is consistent with our study.…”

Mean Platelet Volume in Neonatal Sepsis- A Case Control Study

“…This study shows that the most frequent symptoms of NS were refusal to suck (43.5%), lethargy (30.9%), respiratory distress (21.1%), hypothermia (14.3%), fever (9.4%) ( Table 2). The clinical presentation slightly varied between studies in that the study done by Masoumeh Hematyar et al [6] showed respiratory distress in (44.5%), jaundice in (25.5%), vomiting in (23.6%) and poor feeding in (20.9%), lethargy (10.9%), fever (3.6%), seizure (1.8%), & in another study by Mohsen M. Shalaby et al [7] the most common clinical features of neonatal sepsis were poor suckling (87.5%), respiratory distress (82.5%) and lethargy (77.5%). Among the laboratory investigations for sepsis screening, the total WBC count, Absolute Neutrophil Count (ANC), and Creactive protein (CRP) showed statistically significant increase in group A and B than group C. On comparison of MPV among the three groups, a statistically significant increase in MPV was found in group A and B (cut off 10 fl) than group C (P <0.001).…”