Abstract
Neonatal sepsis is a common reason for neonatal morbidity and mortality. Only clinical manifestations are inadequate to diagnose neonatal sepsis. In context of Nepal, there has been few studies correlating bacterial and clinical profile but none till now has managed to define the most adequate parameters to diagnose neonatal sepsis with certainty. Hence, this study is conducted to describe and compare clinical and laboratory characteristics of culture positive and clinically suspected sepsis (blood culture negative) and then assess whether differences exist between them. A descriptive prospective study was carried out for a period of one year starting from April 2017 to March 2018 at the NICU of Kathmandu Medical College. A total of 129 culture proven and suspected septic neonates were included. Clinical features, septic screening including blood culture, biochemical tests and radiological findings were taken into consideration. The incidence of definite neonatal sepsis was 22.4%. The most common bacterial isolates were gram negative bacteria. Klebsiella spp (48%) followed by CoNS (17%), Acinetobacter spp (14%), Enterobacter spp (7%), Pseudomonas (7%) and Staphylococcus aureus (7%) were isolated. Different non specific clinical features like respiratory and gastro-intestinal symptoms were seen. The neonates with clinical features had positive correlation with abnormal laboratory parameters with statistically significant p value, suggesting that septic neonates showed abnormal laboratory parameters. This data emphasizes the role of laboratory parameters other than blood culture for the diagnosis and empirical treatment of neonatal sepsis.
Highlights
Neonatal mortality accounts for more than 1/3 of child deaths worldwide,[1] out of which, neonatal sepsis causes 1/4 of total neonatal deaths
Neonatal sepsis is a common reason for neonatal morbidity and mortality with an annual incidence of 2-6 per 1000 live births in the developed countries of the world[3] whereas in developing countries, mortality rate due to neonatal sepsis is between 11-68/1000 live birth.[4]
A descriptive study was carried out from April 2017 to March 2018 based on prospective data collected in neonatal intensive care unit (NICU) of Kathmandu Medical College Teaching Hospital (KMCTH)
Summary
Neonatal mortality accounts for more than 1/3 of child deaths worldwide,[1] out of which, neonatal sepsis causes 1/4 of total neonatal deaths. About 99% of these neonatal deaths take place in developing nations.[2] Neonatal sepsis is a common reason for neonatal morbidity and mortality with an annual incidence of 2-6 per 1000 live births in the developed countries of the world[3] whereas in developing countries, mortality rate due to neonatal sepsis is between 11-68/1000 live birth.[4]. Neonatal sepsis is defined as a clinical syndrome in an infant 28 days of life or younger, manifested by systemic signs of infection and isolation of a bacterial pathogen from the bloodstream.[5] Group B Streptococcus (GBS), a gram positive organism, is the most common organism of neonatal sepsis in Europe and North America. There is dominance of gram negative organism in developing countries.[6]
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