Early-onset Neonatal Sepsis Group Research Articles

Vitamin D Levels and Early Onset Sepsis in Newborns

Aim: To find out association between vitamin D level and early onset neonatal sepsis (EONS). Methods: This case control study was conducted at a tertiary care center in Northern India during June 2018 to May 2019. Neonates with culture-proven EONS were included as case and neonates without EONS were enrolled as control. 25OH-D levels were evaluated with other routine blood samples. Statistical analysis was done by using unpaired t test and chi-square test. Results: Sixty-two infants were enrolled in each group; baseline characteristics were comparable in both groups. Risk of EONS increased 8 times in neonates with 25OH-D level <30 ng/mL (odds ratio = 8.2; 95% confidence interval [CI]: 3.08-21.82; P = .000). The 25OH-D level was significantly lower in EONS group than control group. Optimal cut-off for 25OH-D was 25 ng/mL to predict EONS with a sensitivity and specificity of 88.7% and 79%, respectively (area under the curve: 0.84; 95% CI: 0.76-0.92; P = .000). Conclusions: Vitamin D insufficiency is significantly associated with EONS. Vitamin D deficiency significantly increases risk of EONS. Maternal vitamin D supplementation may improve neonatal vitamin D levels and may decreases risk of EONS. Further studies including maternal vitamin D level are required for implementation.

Comparative study of diagnostic value of Apo lipoprotein AI in neonatal sepsis in Relation to hematological score

Objective The aim of this study is to study serum level of Apolipoprotein A1 as a diagnostic marker in neonatal sepsis in relation to haematological score. Background: Neonatal sepsis has become a global health problem due to its high morbidity and mortality. Blood culture continues to be the main method to diagnose neonatal sepsis. The present work aimed to study of serum level of Apolipoprotein A1 as a diagnostic marker in neonatal sepsis in Relation to Hematological score. Methods: This study is a case control study, which was done on 60 neonates who admitted to neonatal ICU (NICU) of Benha University Hospitals and Benha Teaching Hospitals of both sexes after obtaining an informed consent from the children's caregiver. Group I: 40 neonates with a positive clinical sepsis score (CSS) and hematological sepsis score (HSS). Group I were subdivided into two subgroups A , B: Subgroup A: 20 Neonates with early Sepsis within the first 7 days of life. Subgroup B: 20 Neonates with late Sepsis after 7 days of life. Group II (Controls) included 20 healthy neonates with no evidence of sepsis. This study was carried out in Al-Qalubyia Governorate, from June 2019 to May 2020. Results: There was significant increase in HSS in sepsis group than control. Klebsilla was the common organism. there were statistically significant decrease in serum level of Apolipoprotein A1 at diagnosis among cases than control.There was no statistically significant difference between Early onset neonatal sepsis group and Late onset neonatal sepsis group regarding HSS at diagnosis.There were no statistically significant difference between Early onset neonatal sepsis group and Late onset neonatal sepsis group regarding serum level of Apolipoprotein A1 at diagnosis. Serum level of Apolipoprotein A1 at diagnosis was statistically significant lower among Early onset neonatal sepsis group than Control group. Serum level of Apolipoprotein A1 at diagnosis was statistically significant lower among late onset neonatal sepsis group than Control group. There were statistically significant positive correlation between serum level of Apolipoprotein A1 at diagnosis and Platelet count, and there was no statistically significant difference between serum level of Apolipoprotein A1 at diagnosis and other numerical data.Serum level of Apolipoprotein A1 is more accurate in the diagnosis of neonatal sepsis than HSS. Conclusion: Apo A1 appeared to be a useful marker for the early detection and diagnosis of neonatal sepsis than HSS.

Diagnostic Accuracy of Clinical Tool 'STOPS' and Serum Procalcitonin for Optimizing Antibiotic Therapy in Neonates Born at ≥ 28 Weeks of Gestation with Neonatal Sepsis.

BackgroundAntibiotic therapy is initiated in neonates on suspicion of sepsis. Optimizing therapy is a felt need of clinicians as prolonged injudicious use increases mortality and morbidity risk.ObjectiveTo evaluate the diagnostic accuracy of clinical tool 'STOPS' and serum procalcitonin (PCT) for identifying neonates with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) and early discontinuation in those with no sepsis.MethodsThe study had a prospective analytical design conducted at a tertiary care hospital. Consecutively admitted neonates with suspected EONS or LONS were enrolled. The 'STOPS' tool comprising sensorium, temperature, oxygenation, perfusion, skin color, and blood sugar was applied at 6 and 12 hours of enrollment. Serum PCT was sent at 12 hr. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) were estimated.ResultsThe study enrolled 380 neonates, of which 330 were given antibiotics for EONS and 50 for LONS. Temperature disturbance in the EONS group at 12 hr showed a PPV of 100% and a PLR of 9.1 (7.7 – 18). Perfusion assessment at 12 hr had a PPV of 77% and PLR of 8.25 (2.3 – 29). Skin color assessment at 12 hr had a PPV of 100% and PLR of 13.5 (9.7 – 27). The diagnostic accuracy of PCT in the EONS group was unremarkable. In the LONS group, skin color at 12 hr had a PPV of 100% and PLR of 11.2 (8.6 – 19.5). The diagnostic accuracy of PCT in the LONS group showed a PPV of 82% and PLR of 7 (1.7 – 29).ConclusionIdentifying abnormal STOPS parameters was superior to PCT alone in EONS and as good as PCT in LONS. The 'STOPS' tool allows early identification of neonates with no sepsis, thereby optimizing antibiotic use.

The value of interleukin-6 (IL-6) within 6 hours after birth in the prompt diagnosis of early-onset neonatal sepsis.

BackgroundTo investigate the value of interleukin-6 (IL-6) for neonates within 6 hours after birth in the prompt diagnosis of early-onset neonatal sepsis (EONS).MethodsThe clinical and laboratory data of 129 neonates in the neonatal intensive care unit (NICU) of our center from March 31, 2017, to February 29, 2020, were retrospectively analyzed. These patients were divided into two groups on their disease conditions: the EONS group (n=66) and the healthy control group (n=63). All enrolled patients were born in our hospital’s Obstetrics Department and were admitted to the NICU within 2 hours after birth. The first session of the blood test was conducted within 4–6 hours after birth for the measurements of IL-6, C-reactive protein (CRP1), serum amyloid A1 (SAA1), and serum immunoglobulin M (IgM). The second session of the blood test was performed 12–24 hours after birth for procalcitonin (PCT), CRP2, and SAA2. All the tests were completed in our clinical laboratory. The non-parametric test (Mann-Whitney U test) was used to compare all parameters between these two groups. The receiver operating characteristic (ROC) curves were drawn to compare the diagnostic sensitivities and specificities. The pairwise comparisons of the ROC curves were on the MedCalc18.2.1 software. A P value of <0.05 was considered statistically significant.ResultsGender, birth weight, and gestational age were matched between the EONS group and the control group (all P>0.05). The differences of IL-6, CRP2, PCT, and SAA2 were statistically significant between these two groups (all P<0.05), while there was no significant difference in CRP1, SAA1, and IgM (all P>0.05). The area under the ROC curve (AUC) is 1 (95% CI: 0.918–1.000), 1 (95% CI: 0.918–1.000), 1 (95% CI: 0.918–1.000), and 0.977 (95% CI: 0.878–0.999), respectively, for IL-6, CRP2, PCT, and SAA2. Pairwise comparisons among four biomarkers showed the diagnostic specificity and sensitivity of IL-6 were not significantly different from those of CRP2, PCT, and SAA2 (all P>0.05).ConclusionsIL-6 is a quick and independent diagnostic biomarker for EONS, and its sensitivity and specificity are inferior to the conventional inflammation markers, including CRP, PCT, and SAA.

Interleukin-6 as a Biomarker of Early-Onset Neonatal Sepsis.

The aim of this study is to determine the utility of C reactive protein (CRP) and interleukin (IL)-6 in the diagnosis of neonatal sepsis (NS) in a neonatal intensive care unit (NICU) in the south of Colombia. A nonmatched case-control study was conducted. Convenience sampling was performed. Data were obtained from clinical records. IL-6 levels were determined using enzyme-linked immunosorbent assay. Receiver operator characteristic (ROC) curve analysis and Youden's index were used to determine the optimal cutoffs for CRP and IL-6 levels in diagnosing NS, early-onset NS (EONS), and late-onset NS (LONS). Data from 31 cases and 62 controls were included. History of chorioamnionitis (infinite odds ratio [OR] [3.07-infinity]), and the presence of meconium-stained amniotic fluid during birth (OR: 9.04 [1.35-112]) were identified as risk factors for NS. Differences in CRP (p < 0.0001) and IL-6 (p < 0.0485) levels were also found, more significantly for LONS and EONS patients, respectively. In the diagnosis of LONS using CRP levels, the area under the ROC curve (AUC) was 0.8371 (p < 0.0001). The optimal cutoff was 0.53 mg/dL. For EONS diagnosis using IL-6, the AUC was 0.6869 (p = 0.0315) and the optimal cutoff was 17.75 pg/mL. Differences between CRP and IL-6 levels were found between control and NS groups. Furthermore, CRP showed greater potential diagnostic utility in the LONS group, whereas IL-6 showed greater potential utility in the EONS group. · NS is a major morbimortality cause worldwide. · CRP and IL-6 levels may be useful NS biomarkers. · No biomarker alone is enough for the diagnosis of NS.

Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017.

Neonatal sepsis (NS) remains a major cause of morbidity and mortality in neonates, but data on the etiology and antibiotic susceptibility patterns of pathogens are limited. The aim of this study was to analyze the clinical characteristics, risk factors, and the antibiotic susceptibility patterns of pathogenic microbes associated with NS at a tertiary children's hospital in Shanghai, China.Episodes of blood culture-proven sepsis in the neonatal intensive care unit (NICU) of Children's Hospital of Fudan University from January 2013 to August 2017 were retrospectively reviewed. Collected data included demographics, perinatal risk factors, clinical symptoms, laboratory values, microbiology results and their antimicrobial susceptibility. Data for early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) were compared.The 341 of 976 culture-positive cases were selected, including 161 EONS cases (47.21% of 341) and 180 LONS cases (52.79% of 341). 635 incomplete cases were excluded. There was significant difference in risk factors between the EONS group and LONS group including birth weight, gestational age, 1-minute Apgar score, respiratory support, and the use of peripherally insertion central catheter (PICC). Clinical symptoms such as fever, feeding intolerance, abdominal distension, and neonatal jaundice, and laboratory results such as hemoglobin and lymphocyte counts also showed between-group differences. Staphylococcus epidermidis (22.87%), Escherichia coli (9.68%), Alcaligenes xylosoxidans (9.38%) and Klebsiella pneumoniae (9.09%) remain the principal organisms responsible for neonatal sepsis. Most isolates of Gram-positive bacteria were sensitive to vancomycin, linezolid, minocycline and tigecycline, of which more than 90% were resistant to penicillin. Most isolates of Gram-negative bacteria were sensitive to amikacin and imipenem and resistant to ampicillin. Fungus was sensitive to antifungal agents. Better medical decisions, especially early detection and appropriate initial antimicrobial therapy can be made after understanding the different clinical features and pathogens of EONS and LONS.

Association between Tumor Necrosis Factor-α Promoter -308 G/A Polymorphism and Early Onset Sepsis in Preterm Infants.

Early-onset neonatal sepsis (EOS) is diagnosed during the first 7 days of neonatal life and is the major cause of morbidity and mortality among preterm infants. Genetic predisposition may have an impact on EOS susceptibility and outcome. The aim of our study was to explore the association between TNF-α -308 G/A or IL-6 -174 G/C gene polymorphism and the susceptibility and outcome of EOS in preterm infants. The study included 471 preterm infants: 282 with EOS (151 with culture proven sepsis and 131 with clinical sepsis) and 189 without infection (control group). TNF-α -308 G/A and IL-6 -174 G/C were genotyped using Real-time RCR method. We observed significantly higher frequency of A allele of TNF-α -308 G/A polymorphism in blood culture proven EOS (p = 0.017) or clinical EOS (p = 0.025) compared with the control group. Logistic regression confirmed significant association between TNF-α -308 GA+AA genotypes and development of culture proven EOS (B = -0.718, p = 0.013) or clinical EOS (B = -0.602, p = 0.027). No significant differences in IL6 -174G/C alleles or genotypes distribution have been observed between culture proven EOS group, clinical EOS group and the control group. An association between TNF-α -308 G/A or IL-6 -174 G/C genotypes and EOS lethal outcome was not observed (p = 0.652 and p = 0.384, respectively). According to our analysis of large cohort of preterm infants with clearly defined EOS groups, the TNF-α -308 A allele may be a risk factor for the EOS occurrence.

Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis.

PurposeTo determine the diagnostic value of eosinopenia and the neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of early onset neonatal sepsis (EONS).MethodsThis cross-sectional study was conducted in the Neonatology Ward of R.D. Kandou General Hospital Manado between July and October 2017. Samples were obtained from all neonates meeting the inclusion criteria for EONS. Data were encoded using logistic regression analysis, the point-biserial correlation coefficient, chi-square test, and receiver operating characteristic curve analysis, with a P value <0.05 considered significant.ResultsOf 120 neonates who met the inclusion criteria, 73 (60.8%) were males and 47 (39.2%) were females. Ninety (75%) were included in the sepsis group and 30 (25%) in the nonsepsis group. The mean eosinophil count in EONS and non-EONS groups was 169.8±197.1 cells/mm3 and 405.7±288.9 cells/mm3 , respectively, with statistically significant difference (P<0.001). The diagnostic value of eosinopenia in the EONS group (cutoff point: 140 cells/mm3 ) showed 60.0% sensitivity and 90.0% specificity. The mean NLR in EONS and non-EONS groups was 2.82±2.29 and 0.82±0.32, respectively, with statistically significant difference (P<0.001). The diagnostic value of NLR in the EONS group (cutoff point, 1.24) showed 83.3% sensitivity and 93.3% specificity.ConclusionEosinopenia has high specificity as a diagnostic marker for EONS and an increased NLR has high sensitivity and specificity as a diagnostic marker for EONS.

The diagnostic utility of procalcitonin, interleukin-6 and interleukin-8, and hyaluronic acid in the Norwegian consensus definition for early-onset neonatal sepsis (EONS).

IntroductionA key challenge in identifying serious bacterial infection in new born infants is the nonspecific clinical presentation of early-onset neonatal sepsis (EONS). Routinely used C-reactive protein, white blood cell count, and platelets are nonspecific. We assessed the diagnostic utility of single biomarkers or combinations of procalcitonin (PCT), interleukin (IL)-6, IL-8, and hyaluronic acid (HA) in newborn infant with EONS, and in human umbilical cord blood (HUCB) from deliveries with chorioamnionitis.Materials and methodsBlood was collected from term infants with strictly defined EONS (group 1, n=15), healthy term infants (group 2, n=15), and the umbilical vein from pregnancies with suspected chorioamnionitis (group 3, n=8), and from healthy pregnancies with no signs of infection (group 4, n=15).ResultsNeonatal plasma PCT and IL-8 showed good predictive value (90% and 83%) for EONS, and the combination of IL-6 or HA with PCT increased the predictability to 87% and 90%, respectively. PCT, IL-6, IL-8, and HA were 8.4-, 4.5-, 3.6-, and 1.9-fold higher when compared with plasma levels in noninfected neonates. PCT, IL-6, and IL-8 in HUCB predicted chorioamnionitis and fever in the delivering mother (89%, 83%, and 72%, respectively). HA was a poor predictor (59%), but its predictability increased in combination with PCT, IL-8, or IL-6. In HUCB from chorioamnionitic deliveries, IL-6, IL-8, and PCT were 23-, 14-, and 2.4-fold higher, respectively, when compared with HUCB from healthy deliveries. There was no correlation between C-reactive protein, white blood cell, and platelet count with PCT, IL-6, IL-8, or HA.ConclusionIn neonates that fulfilled the Norwegian consensus definition of neonatal sepsis, PCT, IL-6, and IL-8, but not HA, have the potential to improve our management of neonates at risk. Except for PCT and IL-8, both with a predictability of >80% in neonatal plasma, combinations of biomarkers increased the predictability for EONS and chorioamnionitis.

Relationship between Early-Onset Neonatal Sepsis and Red Blood Cell Distribution Width (RDW)

Background: Comparative studies have shown the correlation between sepsis, septic shock and red blood cell distribution width (RDW) in the adult population. There is limited information about the association between RDW and neonatal sepsis. Aims: In this study we purpose to compare RDW in healthy new-born and those with early-onset neonatal sepsis (EONS) and to investigate the potential role of RDW in the diagnosis of EONS. Study design: The type of this study is prospective cohort study. Methods: Study population consisted of term and near-term new-born delivered by spontaneous vaginal births. EONS (n=43) and control (n=45) groups were compared for RDW, complete blood cell count (CBC), and C-reactive protein (CRP) levels. Results: In new-born in the EONS group significantly higher levels of white blood cell (WBC) (19.60 ± 6.30 103/mm3 vs. 15.48 ± 5.46 103/mm3; p=0.002), RDW (22.35 ± 5.27% vs. 15.33 ± 1.87%; p<0.001) and CRP (21.2 ± 19.06 mg/L vs. 2.71 ± 0.76 mg/L; p<0.001). A significant and positive correlation was detected between RDW and serum CRP (r=0.26; p=0.01) levels. According linear regression model CRP (β=0.42; p<0.001), RDW (β=0.529; p<0.001) and WBC (β=0.171; p=0.011) were associated with EONS. Conclusion: RDW was observably higher in term and near-term new-borns with EONS. Besides we detected significant correlations between RDW and CRP in the EONS. RDW can be used with CRP for the diagnosis of EONS.

Diagnostic Value of Presepsin in Detection of Early-Onset Neonatal Sepsis.

Objective The aim of this study was to evaluate the efficacy of presepsin in both diagnosis and follow-up of early-onset neonatal sepsis (EOS) and also to compare its effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). Methods A total of 29 term infants with EOS group and 40 term infants with control group were included in this study. Before initiating therapy, blood samples for whole blood count, CRP, PCT, presepsin, and culture were obtained from all neonates (T0). This procedure was repeated two times at 72 hours (T3) and day 7 (T7). Results Presepsin levels of sepsis group at T0 were significantly higher (704.27 ± 223.54 pg/mL) than the control group (508.33 ± 165.46 pg/mL). The sensitivity of CRP, PCT, and presepsin at T0 was found to be 83, 67, and 80%, whereas the specificity was found to be 75, 67, and 75%, respectively. The cutoff value for presepsin was 539 pg/mL with an area under the curve of 0.772. Conclusion Presepsin may be used as a reliable and accurate marker for both diagnosis and follow-up of EOS. However, to increase the accuracy, presepsin may be used in combination with other markers such as CRP and PCT.

Serum Mannose Binding Lectin Levels in Early Onset Neonatal Sepsis

Introduction: Early Onset Neonatal Sepsis (EONS) is still the most cause of neonatal morbidity and mortality. The diagnosis is difficult to establish because of nonspecific clinical features and laboratory findings. Mannose binding lectin (MBL) is one of the acute phase proteins that can show progressing infection process. Objective: To determine the serum MBL levels of neonates with EONS and not EONS. Methods: This study was conducted as a cross sectional study from September to November 2014. The population included 92 neonates baby whose mother has risk factors of sepsis and admitted to Dr. Wahidin Sudirohusodo Hospital and joined hospital. The subjects were divided into two groups, EONS and Not EONS group based on clinical features and laboratory findings. The MBL serum level was measured on each group. Results: Statistical analyses showed median value of serum MBL of EONS group (0.88 μg/mL) was significant lower compare with Not EONS group (0.93 μg/mL), with p= 0.00 (p<0.05). The cutoff point of ≤0.93 µg/mL is the best levels to distinguish between EONS and Not EONS (p=0.01, sensitivity 76%, specificity 56%, positive predictive value 60%, negative predictive value 67%, COR 3.182, 95%CI 1.306-7.752). Conclusion: MBL serum levels on EONS group were lower than Not EONS group.

PO-0571 Pathogens And Empiric Treatment Of Sepsis In A Neonatal Intensive Care Unit

<h3>Background and aims</h3> Sepsis is a major cause of morbidity and mortality in newborns. We aimed to assess the efficacy of the current empiric regimens commonly used in neonatal intensive care units (NICU) and to describe the characteristics of newborns with sepsis. <h3>Methods</h3> Infants admitted to the NICU with a sepsis diagnosis during January 2012 and December 2013 were assessed in a retrospective manner. While infants with early onset neonatal sepsis (EO-NS) diagnosis had received an empiric regimen including ampicillin and gentamicin, those with a late onset neonatal sepsis (LO-NS) diagnosis received carbapenem, vancomycin and fluconazole. Culture antibiogram results were compared with empirical treatment choices. Mortality and recovery rates with empiric treatment was documented. We used the MedCalc statistical software for statistical analysis. <h3>Results</h3> We identified 124 infants (66 males and 58 females). Of these 43 (34.7%) were diagnosed with EO-NS and 81 (65.3%) with LO-NS. While the rate of positive blood culture results was 36% in the EO-NS group it was 84% in the LO-NS group. Treatment success rates were 93,5% in the EO-NS group, and 81,7% in the LO-NS group. Carbapenem resistance was identified in 10,5% of the newborns in the LO-NS group. Mortality rates were 4.6% in the EO-NS and 8,9% in the LO-NS group. <h3>Conclusions</h3> The success rates of empiric antibiotic treatment was high in both the EO-NS and LO-NS group. The microbial flora of the NICU should be taken into account when deciding for the empirical antibiotic treatment regimens in infants with hospital acquired sepsis.