DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20202611

Forecasting the possibility of neonatal early onset sepsis based on perinatal risk factors

Kiran C. Pankaj, Sristi Ganguly, Manas R. Upadhyay

Abstract


Background: Neonatal sepsis remains a leading cause of neonatal mortality and morbidity, diagnosis of which remains difficult due to variable presentations. With the increasing threat of antimicrobial resistance, it is important to identify perinatal risk factors which are associated with higher incidence of definite sepsis, to initiate empirical antibiotics, while awaiting blood culture reports.

Methods: This was hospital based cross-sectional study done in SVPPGIP, Cuttack, Odisha during January 2019 to April 2019, enrolling all neonates  ≥37 weeks gestation and aged less than 72 hours, with suspected early onset sepsis. Neonates with TORCH infections, congenital anomalies, syndromic baby or with surgical conditions were excluded. After obtaining informed consent, blood culture was sent for all and their perinatal risk factors noted. Blood culture positive newborns were considered to have definite sepsis. Data was analysed with Chi-square test and percentages, using SPSS 18.

Results: Among the 200 cases, incidence of definite sepsis was 26%. The most common risk factor was low birth weight and birth asphyxia. Majority (67%) had single or lesser risk factor and number of risk factors was significantly associated with definite sepsis. A significant association was seen between blood culture positivity with low birth weight (p=0.003), foul smelling liquor (p= 0.025), birth asphyxia (p 0.018) and premature rupture of membranes (p= 0.016). The combination of maternal fever and unclean vaginal examination was also significantly associated with the same.

Conclusions: Protocols for initiating empiric antibiotics need to be formulated, taking into account the significant risk factors, in resource limited settings, to avoid resource and time wastage.


Keywords


Neonatal sepsis, Perinatal risk factors

Full Text:

PDF

References


Abubakar I, Tillmann T, Banerjee A. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 385(9963):117-71.

Polin RA. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatr. 2012 May 1;129(5):1006-15.

Escobar GJ. The neonatal sepsis work-up. Personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization. Pediatr. 1999 Jan 1;103(Supplement E1):360-73.

Schlapbach LJ, Kissoon N. Defining pediatric sepsis. JAMA Pediatr. 2018; 172(4):312-4.

Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker JN. Antibiotic use for sepsis in neonates and children: 2016 evidence update. WHO Reviews. 2016.

Gerdes JS, Polin R. Early diagnosis and treatment of neonatal sepsis. Indian J Pediatr. 1998;65(1):63-78.

Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med. 2013 Aug;10(8).

Singh M, Narang A, Bhakoo ON. Predictive perinatal score in the diagnosis of neonatal sepsis. J Trop Pediatr. 1994 Dec;40(6):365-8.

Waseem R, Khan M, Tahira SI and Waheed A. Neonatal sepsis. Profess Med J. 2005;4(12);451-6.

Nandy M, Dutta S, Ganguly S, Paul DK, Bandhopadhyay M. Changing spectrum of neonatal septicemia. Child New Born. 2007;11(1):3-6.

Basu R, Bandyopadhyay S. Study on correlation between sepsis screening and blood culture in neonatal sepsis. Morbidity Mortality. IOSR J Dental Med Scien. 2014 May;6:7:52-6.

Pokhrel B, Koirala T, Shah G, Joshi S, Baral P. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal. BMC Pediatr. 2018 Dec 1;18(1):208.

Joshi SG, Ghole VS, Niphadkar KB. Neonatal Gram-Negative Bacteremia. Indian J Pediatr. 2000; 67(1):27-32.

NNPD Report of the National Neonatal Perinatal Database (National Neonatology Forum) 2002-03.

Vandana G, Lokesh S, Praveen,Devi K B, Rani S, Anil S. Haematological Profile in Neonatal Septiceamia. IOSR-JDMS;16(4):11-7.

Baltimore RS. Neonatal nosocomial infections. Semin Perinatol 1998;22:25-32.

Jajoo M, Kapoor K, Garg LK, Manchanda V, Mittal SK. To Study the Incidence and Risk Factors of Early Onset Neonatal Sepsis in an Out born Neonatal Intensive Care Unit of India. J Clin Neonatol. 2015;4(2):91-5.

Kondle VK, Manohar TC. Clinical study of neonatal septicemiawith reference to early indicators of sepsis in NICU, PIMS. PER. 2017;5(3):197-202.

Agarwal M, Chathurvedi P, Dey SK, Narang P. Coagulase negative staphylococcal septicemia in newborn. Indian Pediatr. 1990;27(2):163-9.

Shah GS, Budhathoki S, Das BK, Mandal RN. Risk factors in early neonatal sepsis. Kathmandu Univ Med J (KUMJ). 2006 Apr-Jun;4(2):187-91.

Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Health. 2016;4:e752-60.

Murthy S, Godinho MA, Guddattu V, Lewis LE, Nair NS. Risk factors of neonatal sepsis in India: A systematic review and meta-analysis. PloS one. 2019;14(4).

Oddie S, Embleton ND. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. BMJ. 2002;325(7359):308.

Chacko B, Sohi I. Early onset neonatal sepsis. Indian J Pediatr. 2005 Jan 1;72(1):23.