Assessing the Role of Clinical Manifestations and Laboratory Findings in Neonatal Sepsis

Abstract

Background: Neonatal sepsis is one of the major causes of morbidity and mortality in newborns. Since early diagnosis of neonatal septicemia is important for timely initiation of correct antimicrobial therapy and considering the existence of variability in non-specific clinical laboratories, we assessed the role of clinical manifestations and laboratory findings to find the right diagnosis. Objectives: The aim of this study was to evaluate, record and rank the clinical manifestations and lab data of neonates with clinical sepsis. Methods: In a cross sectional descriptive prospective study in 2013, a total of 110 consecutive infants with clinical manifestations of sepsis were studied in two groups including early onset sepsis (EOS) taking place at 72 hours of age or younger, and late onset sepsis (LOS) occurring after 72 hours. Check list of infant’s data, presenting symptoms or signs and laboratory data in both groups were evaluated and recorded. Significant differences were set at as P < 0.05. Results: Overall, 81.8% of infants had EOS while 18.2% of infants had LOS. The mean age at the time of EOS and LOS presentation was one to two days and four to twelve days, respectively. The most common clinical manifestations were respiratory distress in 49 (44.5%), jaundice in 28 (25.5%), vomiting in 26 (23.6%) and poor feeding in 23 (20.9%) of the infants. Other clinical manifestations were lethargy (weakness), decreased sucking reflex, fever, tremor, abdominal distention and seizure, found in 12 (10.9%), 10 (9.1%), 4 (3.6%), 4 (3.6%), 3 (2.7%) and 2 (1.8%) neonates, respectively. Early Onset Sepsis was considerably associated with respiratory distress (P < 0.001), while LOS in neonates was followed by jaundice (P < 0.001), seizure (P = 0.02) and fever (P < 0.001). Anemia, leukocytopenia, leukocytosis, thrombocytopenia and C-reactive protein (CRP) positive results and blood culture was detected in 36 (32.7%), 2 (1.8%), 0 (0%), 2 (1.8%), 19 (17.3%) and 110 (100 %) neonates, respectively. Cerebrospinal Fluid (CSF) cultures were negative in all infants. Positive urine culture was seen in 10 (9.1%) infants. Conclusions: Respiratory distress is more common in EOS whereas jaundice, fever and seizure are more likely to be observed in LOS infants. Considering the results, clinical manifestations should be regarded as an important part of early diagnosis of sepsis.