DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20180480

Clinical profile and outcome of early onset sepsis in high risk very low birth weight neonates

Omprakash S. Shukla, Aditi Rawat

Abstract


Background: Neonatal sepsis is one of the main causes of mortality and morbidity, especially in very low birth weight neonates (birth weight <1499 grams) despite the progress in hygiene, introduction of new and potent antimicrobial agents for treatment and advanced measures for diagnosis. The aim of the study was to find correlation of clinical features and risk factors of neonatal sepsis in culture positive cases.

Methods: A cross- sectional study was carried out in one hundred neonates with risk factors of septicemia after obtaining informed consent. Blood culture was done using Bactec Peds Plus/F Culture as a gold standard to diagnose septicaemia. Correlation of  risk factors, clinical features with laboratory findings was obtained by using chi-square test. p-value of less than 0.05 was considered as significant.

Results: Out of 100 neonates with suspected sepsis, BACTEC culture proven sepsis was seen in 40% cases. Gram negative sepsis was seen in 62.5% cases. The most common bacteria for early onset sepsis were Klebsiella, Pseudomonas and MRSA contributing 17% each to the bacteriological profile. The most common predisposing factor and clinical feature in culture positive cases were Premature rupture of membrane >24 hours (67%) and bleeding/petechia/pupura (72%) respectively. The major cause of mortality was pulmonary hemorrhage.

Conclusions: Gram negative organism were more common and associated with higher mortality. Blood culture positivity increases with increase in number of risk factors in neonatal septicemia. A detailed history and thorough clinical examination is vital for early recognition of sepsis. 


Keywords


Clinical profile, Bacteriological profile, BACTEC blood culture, Early onset sepsis, Risk factors, Very low birth weight

Full Text:

PDF

References


Sudhir D, Ahmed R, Reddy L, Ramesh K. Profile of neonatal sepsis in a tertiary care hospital: a descriptive study. Int J Curr Res Aca Rev. 2014;2(11):197-202.

SRS statistical report 2013. Available at http://niti.gov.in/content/neo-natal-mortality-rate-nmr-1000-live-births. Accessed on December 10, 2017.

Sanskar MJ, Neogi SB, Sharma J, Chauhan M, Shrivastava R, Prabhakar PR et al. State of newborn health in India. J Perinatol. 2016;36(3):3-8.

Singh M. Care of the newborn. 8th ed. Faridabad: CBS Publisher and distributors;2017:283-297

Kleigman R, Nelson W. Nelson textbook of pediatrics. 1st southeast asian edition. Philadelhia:Elseivier Saunders;2015:909-25.

Cloherty J, Eichenwald E, Hansen A. Manual of Neonatal Care. 7th ed. Philadelphia: Wolters Kluwer;2015:624-55.

Sarangi K, Pattnaik D, Mishra S, Nayak M, Jena J. Bacteriological profile and antibiogram of blood culture isolates done by automated culture and sensitivity method in a neonatal intensive care unit in a tertiary care hospital in Odisha, India. J Adv Med Med Res. 2015;2:387-92.

Maharaja P, Karasimangaya V. Clinical profile and risk factors in neonatal septicemia. ‎Int J Pharma Bio Sci. 2017;8(3):489-95.

Sathyamurthi B, Leela KV, Narayanababu R, Padmanaban S, Sreedevi S, Sujatha et al. Clinical and bacteriological profile of neonatal sepsis in a tertiary care hospital. Int J Sci Stud. 2016;4(8):57-60.

Hoque M, Ahmed A, Halder S, Khan M, Chowdhury M. Morbidities of preterm VLBW neonates and the bacteriological profile of sepsis cases. Pulse. 2010;4(1):5-9.

Kalpana KL. Outcome of neonatal sepsis and statistical analysis of sepsis screening markers for early diagnosis. IOSR J Dent Med Sci. 2016;15(11):40-3.

Kayange N, Kamugisha E, Mwizamholya DL, Jeremiah S, Mshana SE. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania. BMC Pediatr. 2010;10(39):1-9.

Lim WH, Lien R, Huang YC, Chiang MC, Fu RH, Chu SM, et al. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants. Pediatr Neonatol. 2012;53(4):228-34.

Abe R, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Tateishi Y et al. Gram-negative bacteremia induces greater magnitude of inflammatory response than Gram-positive bacteremia. Crit Care. 2010;14:R27.

Munford RS. Severe sepsis and septic shock: the role of gram-negative bacteremia. Annu Rev Pathol. 2006;1:467-96.

Mallow EB, Harris A, Salzman N, Russell JP, Deberardinis RJ, Ruchelli E, et al. Human Enteric Defensins J Biol Chem.1996;271(8):4038-45.

Rognum TO, Thrane PS, Stoltenberg L, Vege Å, Brandtzaeg P. Development of intestinal mucosal immunity in fetal life and the first postnatal months. Pediatr Res. 1992;32(2):145-8.

Evans N, Rutter N. Development of the epidermis in the newborn. Neonatology. 1986;49(2):74-80.

Roy P, Kumar A, Fardid MMA, Kaur IR, Kashyap B. Clinico-bacteriological profile of neonates born with risk factors of septicemia. Indian J Neonat Med Res. 2014;2(1):1-6.

Lim JW, Chung SH, Kang DR, Kim CR. Risk factors for cause-specific mortality of very-low-birth-weight infants in the Korean Neonatal Network. J Korean Med Sci. 2015;30(1):35-44.

Yasmin S, Osrin D, Paul E, Costello A. Neonatal mortality of low-birth-weight infants in Bangladesh. Bull World Health Organization. 2001;79(7):608-14.

Gaiva M, Fujimori E, Sato A. Neonatal mortality in infants with low birth weight. Rev Esc de Enferm USP. 2014;48(5):778-86.