DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192171

Clinical profile and short-term outcomes in neonates with septic shock

C. Sai Sujana, R. J. Meshram, B. B. Lakhkar

Abstract


Background: Neonatal sepsis is a syndrome causing severe organ dysfunction triggered by a dysregulated host in response to an infection, affecting millions of neonates. In such situations, early identification and management in the initial hours dramatically improves the outcome. Hence, it was taken up to study the incidence, clinical profile and short-term outcomes of neonates with septic shock.

Methods: Hospital based prospective observational study on 95 neonates admitted to neonatal intensive care unit in the department of Paediatrics at Acharya Vinobha Bhave rural hospital, Sawangi, Wardha from 1st August 2016 to 31st July 2018.Neonates diagnosed with septic refractory shock were enrolled after taking IEC approval and assent form and those with non-septic aetiology shock were excluded. Statistical analysis was done to establish correlation between neonatal variables and outcome.

Results: 95 neonates fulfilled the inclusion criteria and were recruited. Out of these, 37 and 53 were outborn and inborn respectively. Maximum neonates were preterm and males. Neonates with birth weight 1000-1499 grams to those less than 1000 was 4.2:1. Normal vaginal delivery was more common as compared to lower segment caesarean section (LSCS). Blood culture positivity was in 44.2%. Age of presentation with shock ranged from 1 to 20 days and duration of shock ranged from 2 hours to 192 hours. Most infants were ventilated (84%) and it was more among those who died.

Conclusions: Septic shock is the most common type, carrying high morbidity and mortality (more than 60%). Laboratory and clinical parameters (TLC, Platelet count, CRP, Blood culture, duration of shock, HR, RR, BP or arterial blood gas) (p>0.05) did not carry a prognostic value in predicting the outcome of such neonates. Early identification and intervention remains the key in managing such a challenging neonatal condition.


Keywords


Blood culture, Outcome, Preterm, Refractory, Sepsis, Septic shock

Full Text:

PDF

References


Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol. 2006;35(3):706-18.

Haque KN. (2003) Infection and immunity in the newborn. In: McIntosh N, Helms, eds. Textbook of Pediatrics, 6th ed. Churchill:Livingstone, Edinburgh. 273-290

Stoll BJ, Hansen N, eds. Infections in VLBW infants: studies from the NIC neonatal research network. In: Seminars in perinatology. WB Saunders. 2003;27(4):293-301.

Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome: a prospective study. JAMA. 1995;273(2):117-23.

Brierley J, Carcillo JA, Choong K, Cornell T, DeCaen A, Deymann A, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Critical care medicine. 2009 Feb;37(2):666.

Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Critic Care Med. 2007;35(5):1244-50.

Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, et al. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Sci. 2003;301(5631):386-9.

Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Critic Care Med. 2010;38(5):1276-83.

Lodha R, Vivekanandhan S, Sarthi M, Kabra SK. Serial circulating vasopressin levels in children with septic shock. Pediatric Critical Care Medicine. 2006 May 1;7(3):220-4.

Dahmash NS, Chowdhury MN, Fayed DF. Septic shock in critically ill patients: aetiology, management and outcome. J Inf. 1993;26(2):159-70.

Deorari AK. Nodal centre, AIIMS, New Delhi, New Delhi 2002. National neonatal-perinatal database report 2002-2003. Available at: www.newbornwhocc.org/pdf/nnpd_report_2002-03.PDF.

Silveira RD, Giacomini CB, Procianoy RS. Sepsis and septic shock in the neonatal period: update and review of concepts. Brazil J Int Care Therapy. 2010; 22(3):280-90.

Dong Y, Hou W, Wei J, Weiner CP. Chronic hypoxemia absent bacterial infection is one cause of the fetal inflammatory response syndrome (FIRS). Reprod Sci. 2009;16(7):650.

Silveira R, Procianoy RS. Plasma levels of interleukin-1ß and interleukin-6 in new borns with fever. J Pediatr (Rio J). 1999;75:29-33.

Munford RS, Pugin J. Normal responses to injury prevent systemic inflammation and can be immunosuppressive. Am J Resp Critical Care Med. 2001;163(2):316-21.

Silveira RC, Procianoy RS. Evaluation of interleukin‐6, tumour necrosis factor‐α and interleukin‐1β for early diagnosis of neonatal sepsis. Acta Paediatr. 1999;88(6):647-50.

Meadow W, Rudinsky B. Inflammatory mediators and neonatal sepsis: Rarely has so little been known by so many about so much. Clinic Perinatol. 1995;22(2):519-36.

Biban P, Gaffuri M, Spaggiari S, Zaglia F, Serra A, Santuz P. Early recognition and management of septic shock in children. Pediatr Reports. 2012;4(1).

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999;354(9194):1955-61.