Enhancing neonatal sepsis outcomes: the role of ascorbic acid and thiamine as adjuvant therapies

Roopa B. Mangshetty; Apurva A. Binjanwadgi; Gayathri S. Gaddamanugu

doi:10.18203/2349-3291.ijcp20243083

Authors

Roopa B. Mangshetty Department of Pediatrics, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India
Apurva A. Binjanwadgi Department of Pediatrics, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India
Gayathri S. Gaddamanugu Department of Pediatrics, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20243083

Keywords:

Neonatal sepsis, Ascorbic acid, Thiamine, Adjuvant therapy, NICU

Abstract

Background: Neonatal sepsis, a systemic infection affecting newborns under 28 days, remains a leading cause of global infant mortality and morbidity. It affects approximately 2.8% of live births and accounts for 18% of newborn deaths. Neonates are particularly vulnerable due to their immature immune systems. Current management primarily involves timely antibiotic therapy and supportive care. Emerging evidence suggests potential benefits of micronutrients like ascorbic acid (vitamin C) and thiamine in sepsis management, but research on their combined use in neonatal sepsis is limited.

Methods: This randomized controlled trial was conducted over 18 months involving 120 neonates with sepsis. The intervention group (n=60) received intravenous ascorbic acid (100 mg/day) and thiamine (4 mg/kg/day) for 5 days along with antibiotics, while the control group (n=60) received antibiotics alone. Clinical parameters, duration of hospital stay, NICU stay, antibiotic usage, ventilator support, vasopressor support, laboratory tests, and outcomes were compared between the two groups.

Results: The intervention group showed significantly shorter durations of antibiotic therapy (11.22 vs 13.06 days, p=0.035), NICU stay (7.73 vs 10.91 days, p=0.003), and total hospital stay (12.11 vs 14.55 days, p=0.013) compared to the control group. At discharge, the intervention group had lower C-reactive protein (19.04 vs 33.82, p=0.041) and serum lactate levels (2.55 vs 3.32, p=0.008).

Conclusions: Supplementation of ascorbic acid and thiamine as adjunctive therapy in neonatal sepsis appears to have potential benefits in reducing the duration of hospital stay and NICU stay, and improving certain biochemical markers, without any safety concerns.

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References

Abbott MB, Classes CH. Nelson textbook of pediatrics. JAMA. 2019;306(21):400-1.

WHO. Neonatal mortality rate per 1,000 live births. World Health Organization. 2022. Available at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortalit. Accessed on 17th March 2024.

Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clinical microbiology reviews. 2014;27(1):21-47.

Akhter RJ, Hoque MM, Yasmeen BN, Azad MA. Effect of vitamin C as an adjuvant therapy in neonatal sepsis. Ind J Tra Emerg Pediatrics. 2017;9(3):161.

Schlapbach LJ, Gibbons K, Ridolfi R, Harley A, Cree M, Long D, et al. Resuscitation in paediatric sepsis using metabolic resuscitation–a randomized controlled pilot study in the paediatric intensive care unit (respond picu): study protocol and analysis plan. Frontiers in Pediatrics. 2021;9:663435.

Mehta NM. Resuscitation with vitamins C and B1 in pediatric sepsis-hold on to your “HAT”. Pediatric Critical Care Medicine. 2022;23(5):385-9.

Carr AC. Vitamin C in pneumonia and sepsis. Vitamin C. 2020.

Mallat J, Lemyze M, Thevenin D. Do not forget to give thiamine to your septic shock patient. J Thorac Dis. 2016;8(6):1062.

Aly H, Abd-Rabboh L, El-Dib M, Nawwar F, Hassan H, Aaref M, Abdelrahman S, et al. Ascorbic acid combined with ibuprofen in hypoxic ischemic encephalopathy: a randomized controlled trial. J Perinatol. 2009;29(6):438-43.

Sivanandan S. First Day High Dose Vitamin C and Vitamin E in Hypoxic Ischemic Encephalopathy (following Birth Asphyxia) of Newborn: a Randomized Controlled Trial. Available at: https://papers.ssrn.com. Accessed on 17th March 2024.

Mohite RV, Kshirsagar VY, Rithika D. Effectiveness of vitamin C and E intervention on neurodevelopment of newborn baby with birth asphyxia: A randomized control trial. Curr Pediatr Res. 2024;28(03):2205-8.

Bass WT, Malati N, Castle MC, White LE. Evidence for the safety of ascorbic acid administration to the premature infant. Am J Perinatol. 1998;15(02):133-40.

Sechi GP, Bardanzellu F, Pintus MC, Sechi MM, Marcialis MA, Fanos V. Thiamine as a possible neuroprotective strategy in neonatal hypoxic-ischemic encephalopathy. Antioxidants. 2021;11(1):42.

Equey L, Agyeman PK, Veraguth R, Rezzi S, Schlapbach LJ, Giannoni E, Swiss Pediatric Sepsis Study Group. Serum ascorbic acid and thiamine concentrations in sepsis: secondary analysis of the Swiss pediatric sepsis study. Pedia Critic Care Med. 2022;23(5):390-4.

Zakariya BP, Bhat V, Harish BN, Arun Babu T, Joseph NM. Neonatal sepsis in a tertiary care hospital in South India: bacteriological profile and antibiotic sensitivity pattern. The Indian Journal of Pediatrics. 2011;78:413-7.