Neonatal Sepsis as a Major Cause of Morbidity in a Tertiary Center in Kathmandu

Anurag Thapa,Asha Pun,Badri Thapa,Dhan Raj Aryal,Kishori Mahat,Kusum Thapa,Sudhir Khanal

doi:10.31729/jnma.2424

Anurag Thapa, Asha Pun + Show 5 more

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https://doi.org/10.31729/jnma.2424

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Journal: JNMA: Journal of the Nepal Medical Association	Publication Date: Dec 31, 2013
Citations: 22	License type: cc-by

Affiliation: NLR Nepal

Abstract

Neonatal sepsis causes high morbidity and mortality of newborns. The study aims to study the predictors and clinical, haematological and bacteriological factors of neonatal sepsis. A descriptive cross sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of Paropakar Maternity and Women's Hospital in Kathmandu between October and December 2011. Demographic, obstetrics, clinical and microbiological data were studied for 300 neonates. The NICU prevalence rate of sepsis was 37.12%. Early onset neonatal sepsis was common (91.39%) (P=0.000). Cesarean section (OR 1.95, 95% CI 1.15-3.31), apgar score<4 at 1 min (P=0.00) and <7 at 5 min of birth (P=0.00) predicted sepsis. Neonates with sepsis were more likely to present with hypothermia (OR 1.180, 95% CI 0.080-17.214), pustules (OR 2.188, 95% CI 0.110-43.465), dehydration (OR 3.040, 95% CI 0.170-54.361), diminished movement (OR 3.082, 95% CI 0.433-21.950) and bulging fontanels (OR 16.464, 95% CI 0.007-41495.430). Coagulase negative Staphylococcus spp. (CoNS) (21, 41.17%) was most common pathogen of neonatal sepsis. Variable antibiotic resistance patterns of isolates with emergence of meropenem resistance in Pseudomonas spp. and methicillin resistance in CoNS and S. aurues were noted. Mortality due to sepsis was highest (15, 8.06%) among total mortalities (21, 11.29%). Delivery via cesarian section, apgar score<4 at 1 min, and <7 at 5 min predicted sepsis. Morbidity and mortality of neonatal sepsis was common in this setting and early maternal and neonatal interventions are required to address this issue.

Highlights

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This study evaluated newborns for neonatal sepsis in Paropakar Maternity and Women’s Hospital (PMWH) in Kathmandu, Nepal
All neonates born in PMWH and admitted in Neonatal Intensive Care Unit (NICU) who were being evaluated for neonatal sepsis were enrolled. %CUG FGsPKVKQP HQT EQPsTOGF UGRUKU RTQDCDNG UGRUKU clinical sepsis, early onset neonatal sepsis (EoNS), late onset neonatal sepsis (LoNS), symptoms and signs for neonatal sepsis were used as described previously.[8,9,10]

Summary

Introduction

Sepsis is the commonest cause of neonatal mortality, YJKEJ OC[ GKVJGT JCXG PQPURGEKsE HGCVWTGU QT HQECN signs of infection.[1,2,3] Various fetal and maternal risk factors have been associated with an increased risk of early onset sepsis.[4]. The most common pathogens causing neonatal sepsis include Escherichia coli, Klebsiella pnemoniae, Citrobacter spp., Proteus spp., Staphylococcus aureus and coagulase negative Staphylococcus spp. (CoNS).[5,6]. K. pneumoniae, S. aureus, Pseudomonas spp, and E. coli are the primary pathogens in Asia, India, Africa, Middle East and West Indies are primarily due to. Group B Streptococcus is infrequent.[6].

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