Approach to neonatal sepsis

Abstract

Sepsis is the most common cause of neonatal mortality in developing countries accounting for approximately 30-50% of neonatal deaths. Early diagnosis and treatment of neonatal sepsis is crucial for a favourable outcome. Early onset sepsis can presents within hours after birth and is usually acquired from the maternal genital tract. The clinical signs may be subtle and close monitoring of high risk patients is warranted in this scenario. Late onset sepsis usually presents after seventy two hours of birth and the source of infection in this situation is usually nosocomial or community acquired. Blood culture and sepsis screen are two most important diagnostic as well as corroborative investigations in this situation which also help in deciding the appropriate treatment. Presence of polymorphs in gastric aspirate at birth points towards chorioamnionitis and could be used as a n additional parameter of sepsis screen for diagnosing early onset sepsis. Other useful investigations include lumbar puncture, urine culture and chest radiography. An array of newer diagnostic tests is now available for early diagnosis of neonatal sepsis. These tests are highly sensitive and also have a high negative predictive value. The treatment includes supportive care along with administration of appropriate antibiotics. Adjuvant treatment includes IVIG, GCSF, exchange transfusion and pentoxifylline administration. This paper aims to present an algorithmic approach to neonatal sepsis to expedite the diagnosis along with providing appropriate and adequate treatment.