Clinical profile and outcome of neonates with suspected sepsis form a rural medical college hospital of South India

Abstract

Background: Sepsis is an important cause of neonatal mortality and morbidity. Nonspecific and subtle clinical features coupled with expensive, time consuming and unavailable definite laboratory tests challenges its accurate diagnosis in clinical practice. Sepsis is traditionally suspected in neonates based on clinical features, maternal and neonatal risk factors and is treated by empirical antibiotics. These risk factors and clinical features are variable depending on geographical, cultural and socio-economic background. We studied the clinical and bacteriological profile of high risk neonates for sepsis development in our Neonatal Intensive Care Unit (NICU), to make the precise clinical diagnosis and prevent inadvertent use of antibiotics.Methods: A prospective observational study was conducted on 200 neonates with suspected sepsis either by high risk factors and /or clinical features admitted to NICU for a period of nine months. After clinical examination, septic screen including blood culture was done and antibiotics were started as per the NICU protocol.Results: Of the 200 neonates studied, 20.5% had positive blood culture with Coagulase negative staphylococci (CoNS) and contaminants. 89.5% had early onset of sepsis (EOS). Neonatal profile showed 60.5% males, 55% inborn, 37.5% premature, 49.5% low birth weight babies. Maternal profile showed 49.5% Primigravida, 73% aged above 20 years at delivery and 97.5% literates. Outcome of admitted neonates showed, 72% were discharged after improvement, 10.5% died and 17.5% discharged against medical advice. Death due to respiratory distress syndrome was common in preterm and male neonates.Conclusions: EOS was common in our NICU. Blood culture showed more CoNS and contaminants necessitating the need for better blood sampling and hand wash technique.

Clinicobacteriological profile, antibiotic sensitivity patterns and mortality of neonatal sepsis in a tertiary care hospital in Kashmir, Jammu and Kashmir, India

“…11 The late onset sepsis was more common than early onset (85% vs 15%) similar to early studies like Ahmed ANU et al and Taller SS et al 11,5 The higher incidence of late onset sepsis may be because of use of 72hrs as cutoff for defining early onset sepsis and its higher mortality. Neonatal sepsis was more common in neonates born in rural than in urban (70% vs 30%) similar to studies like Taller SS et al, Rasul CH et al and Iyer CR et al 5,14,15 This could be because of differences in delivery places and lack of trained knowledgeable health care providers in rural areas which may also be reason for higher incidence of sepsis in normal vs caesarean deliveries (80% vs 20%). Our study revealed that neonatal sepsis is more common in low birth babies than normal weight babies (77.5% vs 22.5%) in accordance to studies of Iyer CR et al and Rajana R et al 15,3 The could be because of immunological immaturity and overall high risk behavior of low birth neonates.…”

“…Neonatal sepsis was more common in neonates born in rural than in urban (70% vs 30%) similar to studies like Taller SS et al, Rasul CH et al and Iyer CR et al 5,14,15 This could be because of differences in delivery places and lack of trained knowledgeable health care providers in rural areas which may also be reason for higher incidence of sepsis in normal vs caesarean deliveries (80% vs 20%). Our study revealed that neonatal sepsis is more common in low birth babies than normal weight babies (77.5% vs 22.5%) in accordance to studies of Iyer CR et al and Rajana R et al 15,3 The could be because of immunological immaturity and overall high risk behavior of low birth neonates. Refusal of feeds and lethargy were most common symptoms of neonatal sepsis (67.5% vs 45%) consistent with Jaswal RS et al 16 The gram negative organisms were isolated in 85% of cases consistent with studies done by Mathur M et al, Rasul CH et al and Jaswal RS et al 13,14,16 The most common organisms isolated in our study were klebsiella pneumonia (40%), Escherichia coli (32.2%) and Staphylococcus aureus (15%) in that order consistent with Taller SS et al 5 The probable reason for it being that most of gram negative organisms are normal commensals and neonates are less protected against them because of low IgM antibodies.…”

Neonatal Mortality in the Neonatal Intensive Care Unit at Benghazi Pediatric Hospital– Libya.

“…Whereas a Tripoli-Libya study recorded that prematurity and its complications were the main cause of death (Sherlala et al, 2017). Similarly, deaths due to respiratory distress syndrome were common in preterm and male neonates (Iyer, Naveen, Suma, Kumarguru, & Sweta, 2018). Finally, a study in Indonesia found that hyaline membrane disease, neonatal infection, and prematurity are responsible for high morbidity and mortality rates among neonates (Sastroasmoro, 1998).…”

Incidence of Sepsis and Its Determinants among Neonates Admitted in Level III Neonatal Unit - A Prospective Observational Study

“… 12 Early diagnosis and treatment of neonatal sepsis was a great challenge faced by physician in level III neonatal unit. 13 Diagnosis and management of neonatal sepsis is challenging due to nonspecific clinical feature and variable laboratory parameters. 14 , 15 Delay in identification and treatment of neonatal sepsis are among the main contributors to the high neonatal mortality.…”