The Risk Factors for Development of Sepsis in Newborns with a Central Venous Catheter and their Association with the Serum Zinc Levels

Abstract

Introduction: Neonates with indwelling central venous catheters are at risk of developing the infection. Serum zinc plays a major role in mounting an immune response. Aim: To analyse the risk factors for development of sepsis in hitherto aseptic neonates with a centrally inserted venous catheter and to study their association with the serum zinc levels. Materials and Methods: After Institutional Ethics Committee Approval, 132 neonates were included who required Neonatal Intensive Care Unit (NICU) admission and had an indwelling central venous catheter and their serum zinc levels were measured. Only neonates who were proven aseptic at admission were included and were followed up for development of signs of sepsis using the Clinical Sepsis (CSEP) criteria, baseline septic screen parameters and blood culture, at admission and on the Day 5 along with catheter site culture. This was then correlated with their serum zinc levels and analysed by MannWhitney’s test using SPSS 17.0. Results: Out of 132 neonates, 19 had low and 113 neonates had normal zinc levels respectively (Zn 55µg/dL). A total of 25% neonates developed clinical sepsis by day 5 and 23.5% of neonates had positive catheter site culture. Neonates without clinical sepsis had slightly higher levels of zinc as compared to neonates who had clinical sepsis (147µg/dL and 141 µg/dL respectively). Neonates born to mothers without risk factors and neonates without perinatal asphyxia had higher zinc levels. Neonates with perinatal asphyxia showed statistically significant association with serum zinc levels (94.2 mcg/dL in asphyxiated newborns as compared to 131 mcg/dL in nonasphyxiated newborns). Neonates with significant bandneutrophil ratio on Day 5 had lower zinc levels than those with normal band-neutrophil ratio (107 µg/dL and 111 µg/dL). Conclusion: The risk factor for sepsis in neonates with indwelling catheters associated with zinc deficiency was perinatal asphyxia. Prematurity, low birth weight, maternal risk factors and clinically septic newborns had lower zinc levels,though statistically not significant.