Newer Concepts and Management of Neonatal Sepsis

Abstract

Despite extensive research into its patho-physiology, investigations and treatment, sepsis remains an important cause of neonatal morbidity and mortality. The inddence in developing countries is 10 times that in the developed world. A large number of pro-and anti-inOammatory cytokines (interleukins, eicosanoids, tumour necrosis factor-alpha, nitric oxide) have been identified, the interplay of which leads to the Systemic InOammatory Response Syndrome (SIRS) which can have devastating consequences on all systems of the body. In Indla the common organisms include Staphy1«occus, E coli, Klebsiella and Candida. A number of maternal and neonatal risk factors have been identified. The Initial signs and symptoms are subtle and can easily be missed. Early investigations and screening tests are important and a promising number of new tests are being studied. The gold standard for diagnosis is a positive culture from a body Ouid or local source in the presence of SIRS. The threshold for starting antibiotics should be low in high-risk neonates and broad spectrum antibiotics covering the likely organisms should be given intravenously in all suspected cases in a hospital setting. This should be continued for at least 24-48 hours (till negative reports are available) in suspected cases and for 3 weeks in proven cases. Prophylaxis is aimed at preventing nosocomial and cross infections. Strict hand.washing, meticulous asepsis protocols, identiOcation of high risk groups and prompt and better screening tests are essential in controlling this problem.

Factors Associated with Hand Washing Among Healthcare Personnel in Delivery Points at a Tertiary Care Hospital, South India

“…An estimated 3 million neonates are affected by sepsis worldwide (22 per 1000 live births) with a mortality of 11 -19% [3]. Its incidence in developing countries like India is 10 times more than in developed countries [4]. 99% of global neonatal mortality due to sepsis occurs in low and middle-income countries [5].…”