Достовірні і сумнівні діагностичні критерії раннього неонатального сепсису

Abstract

Neonatal sepsis is a significant cause of mortality among newborns, especially in low and middle income countries with poor economic development. It is important to start the appropriate treatment as soon as possible, as this prevents most deaths from sepsis and reduces the occurrence of residual neurological lesions due to septic meningitis. The article provides an overview of modern literature data on the principles of diagnosis of early neonatal sepsis; mentions the main etiological factors and ways of infection by potential pathogens. Diagnostic criteria for early neonatal sepsis have been analyzed and have been classified as doubt-ful or credible. An important role is given to the assessment of potential risk factors for the development of the septic process, including data on history of pregnancy and childbirth, clinical and laboratory indicators of the baby after birth. The nonspecificity of most clinical signs of sepsis and their comparison with clinical manifestations in meningitis was carried out. The importance of the bacteriological method of detecting the pathogen in the blood, urine and cerebrospinal fluid was analyzed, which remains the «gold» standard diagnosis of neonatal sepsis, and the method of multiplex polymerase chain reaction. There is a need to detect sepsis through visual examination, such as chest radiography, computed tomography, magnetic resonance imaging and ltrasonography of the head. The diagnostic value of indicators is described with the complete blood cell count and differential, including some of its components, and markers of inflammatory process, especially the immature-to-total (I/T) neutrophil ratio, C-reactive protein, procalcitonin. The article mentions a method of determining the concentration of immunoglobulin M in the serum, the elevated level of which indicates intrauterine infection. The diagnostic value of glutathione is considered, which is a marker of the functioning of the immune system. Emphasis is placed on the expediency of using Kaiser Permanente calculator to detect signs of sepsis in the first days of a newborn's life and the choice of optimal tactics management in such patients. No conflict of interest was declared by the authors. Key words: sepsis, newborn, diagnosis of infection, neonatal.