DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20195724

Clinical features and septic screen in neonatal sepsis in a teaching hospital in India

Soja Vijayan, Gopalan A. Velayudhan Nair, Dhanya Narayanan

Abstract


Background: Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low and middle-income countries. The purpose of this study was to note the clinical features and analyze the relationship between the septic screen and blood culture positive sepsis in the neonatal unit.

Methods: A one-year descriptive cross-sectional study was carried out at the NICU of a teaching hospital in India.

Results: The incidence of clinically suspected septicemia was 19.3 per 1000 live births and the incidence of blood culture positive septicemia was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organisms causing sepsis were Coagulase negative staphylococci and Klebsiella. In the septic screen CRP was found to have a statistically significant association with blood culture positive sepsis. CRP also had the highest sensitivity and negative predictive value among the studied parameters.

Conclusions: Incidence of blood culture positive sepsis was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organism isolated in neonatal sepsis in the NICU was Coagulase negative staphylococcus. In resource poor settings, CRP continues to be an important tool in diagnosis and treatment of neonatal sepsis.


Keywords


Blood culture, C-reactive protein, Neonatal sepsis, Septic screen

Full Text:

PDF

References


WHO reviews. Antibiotic use for sepsis in neonates and children:2016 evidence update. Available at: https://www.who.int/selection_medicines/committees/expert/21/applications/s6_paed_antibiotics_appendix4_sepsis.pdf. Accessed on 10 September 2019.

Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J. 2009 Jan 1;28(1):S3-9.

National Neonatal Perinatal Database - WHO newborn CC. Available at: http://www.newbornwhocc.org/pdf/nnpd_report_2002-03.PDF. Accessed on 1 September 2019.

Kumar CSV, Neelagaud YF. Incubation period for culture positivity to detect septicaemia in neonates. Indian J Medica Microbiol. 2005; 23(4): 270-5.

AIIMS protocols 2014- Sepsis in the new-born. Available at: https://www.newbornwhocc.org. Accessed on 30 August 2019.

Shah BA, Padbury JF. Neonatal sepsis: an old problem with new insights. Virulence. 2014 Jan 1;5(1):170-8.

Singh M. Perinatal infections. In: Singh M, ed. Care of the Newborn. Revised 8th ed. New Delhi: CBS publishers and distributors pvt. Ltd; 2017:285-294.

Buch AC, Shrivastava V, Kumar H, Jadhav PS. Evaluation of hematological profile in early diagnosis of clinically suspected cases of neonatal sepsis. Int J BAMS. 2011;1(1):01-6.

Bhat YR, Rao A. The performance of haematological screening parameters and CRP in early onset neonatal infections. J Clini Diagnostic Res. 2010 Dec 30;4(6):3331-6.

Swarnkar K, Swarnkar M. A study of early onset neonatal sepsis with special reference to sepsis screening parameters in a tertiary care centre of rural India. Intern J Infect Dis. 2012;10(1):36-42.

Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. J Natural Sci, Biol, Med. 2013 Jul;4(2):306.

Bhale CP, Kale AV, Kale SS, Mahajan M, Mulay SS. Utility of Sepsis Screen in the Early Diagnosis of Neonatal Sepsis. Ind J Neonatal Med Res. 2016 July;4(3):1001-7.

Vinay BS, Girish GN, Adhikari S, Hugara S, Vinay BS. Evaluation of Septic Screen as a Diagnostic Tool for Neonatal Sepsis in a Tertiary Hospital at Mysore. Sch J App Me Sci. 2015;3(2G):1005-10.

Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clini. 2004 Aug 1;51(4):939-59.

Lakhey A, Shakya H. Role of sepsis screening in early diagnosis of neonatal sepsis. J Pathol Nepal. 2017 Mar 30;7(1):1103-10.

Klingenberg CA, Kornelisse R, Buonocore G, Maier RF, Stocker M. Culture-negative neonatal sepsis at the crossroad between efficient sepsis care and antimicrobial stewardship. Frontiers Pediatr. 2018;6:285.

Hassan HR, Gohil JR, Desai R, Mehta RR, Chaudhary VP. Correlation of blood culture results with the sepsis score and sepsis screen in the diagnosis of early-onset neonatal septicaemia. J Clini Neonatol. 2016 Jul 1;5(3):193-8.

Mittal A, Arya S, Charan LS, Saluja S, Chellani H. Evaluation of platelet indices as additional diagnostic tool for neonatal sepsis. Astrocyte. 2018 Oct 1;4(4):205-9.