Early-onset Neonatal Sepsis Research Articles

Diagnostic Accuracy of the Neonatal Early Onset Sepsis Calculator in Screening for Early Onset Sepsis in Neonates More Than 35 Weeks Age of Gestation

Background: Early-onset sepsis (EOS) is a leading cause of morbidity and mortality among neonates. Diagnosis of EOS can be difficult as clinical signs are subtle. The use of the Neonatal EOS Calculator (NEOSC) may help screen high-risk neonates for EOS and may result in a significant reduction in unnecessary antibiotic use. Objective: To determine the diagnostic accuracy of the NEOSC in screening for EOS in neonates more than 35 weeks age of gestation. Methodology: This was a retrospective, case-control study where 245 septic (cases) and 245 non-septic (controls) neonatal and maternal medical records were reviewed. The EOS risk classification from the NEOSC was compared with the actual clinical outcome. An online statistical software (medcalc.org) was used to compute for the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and accuracy of the NEOSC. Results: Based on the NEOSC, only 64 of 245 clinically septic neonates were truly positive for sepsis while 181 were falsely negative for sepsis. Of the 245 non-septic neonates, 3 were falsely positive for sepsis, while 242 were truly negative for sepsis. With a 95% confidence interval, the computed variables showed a Sn 26.12%, Sp 98.78%, PPV 76.12%, NPV 89.95%, PLR 21.33, and NLR 0.75. The accuracy of the NEOSC is 89.33%. Conclusion: The NEOSC had poor sensitivity and is not recommended in screening for EOS in neonates more than 35 weeks age of gestation. It may be used as an adjunct in EOS diagnosis due to its high specificity and accuracy.

28 Blood culture collection practices in NICU; A national survey

Abstract Background Blood cultures are the gold standard in the investigation of neonatal sepsis, which is associated with significant morbidity and mortality. However, there are currently no consensus guidelines for blood collection for culture in newborns. In addition, it can be challenging to obtain sufficient blood volume in infants, which can affect the validity of culture results. Objectives To examine current practices in blood collection for culture in the investigation of neonatal sepsis in NICUs across Canada. Design/Methods A 9-item electronic survey (Appendix A) was sent to each of the 29 level 3 NICUs in Canada, which are equipped to provide highly specialized care for newborns. Results Responses were received from 26 (90%) of the 29 level 3 NICUs. Fifty-six percent of NICUs have blood collection guidelines for the investigation of neonatal sepsis. Forty-eight percent of NICUs routinely collect 1.0 mL of blood per culture bottle. By contrast, 32% of NICUs determine adequate blood volume using body weight and 8% using gestational age. In late-onset neonatal sepsis (LONS), 58% of centres process one aerobic culture bottle. Four NICUs (15%) routinely add anaerobic culture bottles. Few centres draw blood for culture from an indwelling catheter when present as a first-line option in LONS. Specifically, one NICU routinely draws blood from a central venous line and four NICUs (17%) routinely draw from a peripheral arterial line. In early-onset neonatal sepsis (EONS), 73% of NICUs draw blood for culture from umbilical lines, while 72% use peripheral venepuncture. Two centres routinely collect cord blood from the placenta for culture in EONS. Only one NICU applies the concept of differential time-to-positivity (DTP) in suspected central-line associated bloodstream infection (CLABSI) to determine whether a colonized catheter is the true source of infection. Conclusion There is significant practice variation in blood collection for culture in level 3 NICUs across Canada. Standardization of blood collection practices will improve antimicrobial stewardship and appropriate resource utilization, as well as provide reliable estimates of the true incidence of neonatal sepsis in Canada.

Maternal colonization and early-onset neonatal bacterial sepsis in the Gambia, West Africa: a genomic analysis of vertical transmission

ObjectivesTo define bacterial aetiology of neonatal sepsis and estimate the prevalence of neonatal infection from maternal genital tract bacterial carriage among mother-newborn pairs. MethodsWe carried out a cross-sectional study of newborns with clinical sepsis admitted to three hospitals in the Gambia neonatal wards. Neonatal blood cultures and maternal genital swabs were obtained at recruitment. We used whole-genome sequencing to explore vertical transmission for neonates with microbiologically confirmed bloodstream infection by comparing phenotypically-matched paired neonatal blood cultures and maternal genital tract bacterial isolates. ResultsWe enrolled 203 maternal-newborn pairs. Two-thirds (67%; 137/203) of neonates presented with early-onset sepsis (days 0–6 after birth) of which 26% (36/137) were because of a clinically-significant bacterial pathogen. Blood culture isolates from newborns with early-onset sepsis because of Staphylococcus aureus (n = 5), Klebsiella pneumonia (n = 2), and Enterococcus faecalis (n = 1), phenotypically matched their maternal genital tract isolates. Pairwise single-nucleotide variants comparisons showed differences of 12 to 52 single-nucleotide variants only between maternal and newborn S. aureus isolates, presumably representing vertical transmission with a transmission rate of 14% (5/36). ConclusionsWe found a low prevalence of vertical transmission of maternal genital tract colonization in maternal-newborn pairs for early-onset neonatal sepsis in the West African context. Identifying infection acquisition pathways among newborns is essential to prioritize preventive interventions, which could be targeted at the mother or infection control in the hospital environment, depending on the major pathways of transmission.

Combining Complete Blood Count with Differential Count; C-Reactive Protein and Band Neutrophils in Diagnosis of Early onset Neonatal Sepsis

Aim: To assess the diagnostic accuracy of complete blood count with band versus total neutrophil ratio and C-reactive proteins as an efficient analytical procedure for determining early onset sepsis in neonates. Study design: Cross sectional analytical study Place and duration of study: Department of Paediatric Medicine, Abbas Institute of Medical Sciences Muzafarabad, AJ Kashmir from 01-02-2022 to 31-07-2022. Methodology: Fifty patients were enrolled. Coulter counter was used for analyzing leucocytes of the neonates. Thin film-smears were generated by the laboratory scientist for identifying band neutrophils separately from mature neutrophils. C-reactive proteins level <5mg/dl was considered as negative. Thio-glycate-oxide in liquid form was used for 2ml neonatal blood culture analysis mixed in the 20ml medium at 36 degree celsius. Results: There were 28 (56%) males and 22 (44%) females. The mean age of the neonates was 1.6± 0.77 days. The mean weight of the neonates was 2.4±0.51kg with a range of 4-1.2kg. A variance of band versus total neutrophil ratio was significantly higher in cultures which were positive than negative such as 70% vs 25%. There was also significant percentage of C-reactive proteins positive in positive sepsis cultures in comparison to negative blood culture. Conclusion: A combination of complete blood count with differential count, white blood cell analysis with band versus total neutrophil ratio and c-reactive proteins is an efficient early analytical procedure for determining early onset sepsis in neonates as gold standard test blood culture is time taking. Key Words: Complete blood count, C-reactive protein, Total neutrophils ratio, Early onset neonatal sepsis.

Conservative management of newborns with 35 weeks or more of gestational age at risk for early-onset sepsis: a Brazilian cohort study

ObjectiveTo evaluate the conservative management of newborns born at ≥35 weeks of gestational age, at risk for early-onset neonatal sepsis (EOS). MethodsRetrospective, analytic cohort study (2016 to 2019), including newborns ≥35 weeks of gestational at risk of EOS, asymptomatic at birth, managed conservatively in full rooming-in: serial physical examination and clinical observation for at least 48 h. They were classified into three groups, according to the clinical course: asymptomatic (group A), symptomatic for other reasons (group B), and with sepsis (group C). Risk factors, clinical signs and differential diagnoses of sepsis, length of stay, and discharge conditions were evaluated. ResultsThe authors evaluated 769 asymptomatic newborns at risk of EOS. (mean birth weight 2999 ± 485 g and gestational age 37.6 ± 1.7 weeks, respectively) corresponding to 12.2% of rooming-in admissions. The most prevalent risk factors were colonization by Group B Streptococcus (29%), prolonged rupture membrane duration (21.9%) and preterm labor (21.4%). Most of all of them (53.9%) remained asymptomatic (group A). Group B corresponded for 45.3%, and the most common clinical signs were hypothermia (24.5%), tremors (8.7%) and vomiting (8%). Environmental dysthermia (50.7%), prematurity (20.0%), and feeding intolerance (15.7%) were common in Group B. Laboratory tests were performed in 3.5%. Five patients (one confirmed) comprised group C (0.8/1,000 live births). There were no deaths. The median length of stay was 64 h (IQR 50-93). ConclusionThe rate of clinical/confirmed EOS was low. Most of the symptomatic patients only needed clinical evaluation to rule out sepsis. Management was shown to be safe.

Sneathia infections and adverse perinatal outcomes – short communication

The influence of the maternal vaginal microbiome in vaginal birth is an important factor in the pathogenesis of early-onset neonatal sepsis. The incidence of Sneathia infection is hard to assess due to the difficulty in its detection, as special culture conditions are required. The laboratory methods used in its detection are based on molecular analysis. This emergent, anaerobic agent, by ascending from the female genital tract, can colonize and infect the amniotic fluid, fetal membranes, and placenta. Chorioamnionitis, neonatal sepsis, stillbirth, spontaneous premature labor, and preterm prelabour rupture of the membrane are some of the adverse reactions that can be associated with the presence of Sneathia. In conclusion, Sneathia infection, although underestimated due to its virulence, represents an increased risk of maternal-fetal infections, with the risk of developing a series of neonatal complications. The detection and treatment of this infection will contribute to a decrease in neonatal morbidity and mortality.

Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis.

The widespread use of intrapartum antibiotic prophylaxis (IAP) to prevent group B streptococcus (GBS) early-onset sepsis (EOS) is changing the epidemiology of EOS. Italian prospective area-based surveillance data (from 1 January 2016 to 31 December 2020) were used, from which we identified 64 cases of culture-proven EOS (E. coli, n = 39; GBS, n = 25) among 159,898 live births (annual incidence rates of 0.24 and 0.16 per 1000, respectively). Approximately 10% of E. coli isolates were resistant to both gentamicin and ampicillin. Five neonates died; among them, four were born very pre-term (E. coli, n = 3; GBS, n = 1) and one was born full-term (E. coli, n = 1). After adjustment for gestational age, IAP-exposed neonates had ≥95% lower risk of death, as compared to IAP-unexposed neonates, both in the whole cohort (OR 0.04, 95% CI 0.00–0.70; p = 0.03) and in the E. coli EOS cohort (OR 0.05, 95% CI 0.00–0.88; p = 0.04). In multi-variable logistic regression analysis, IAP was inversely associated with severe disease (OR = 0.12, 95% CI 0.02–0.76; p = 0.03). E. coli is now the leading pathogen in neonatal EOS, and its incidence is close to that of GBS in full-term neonates. IAP reduces the risk of severe disease and death. Importantly, approximately 10% of E. coli isolates causing EOS were found to be resistant to typical first-line antibiotics.

NEONATAL SEPSIS AND PROLONGED RUPTURE OF M EMBRANES

Background: Prolonged rupture of membranes (PROM) is considered when the duration of rupture of amniotic membranes is more than 18 hours prior to delivery. PROM is one of the common risk factors for early-onset neonatal sepsis. Timely identication of sepsis is important.The aim of the study was to determine the outcome and requirement of prophylactic use of antibiotics in newborns born to PROM. Materials & methods: A retrospective study on neonates born to mothers with PROM was conducted from December 2019 to December 2020. Total of 54 neonates fullling the inclusion criteria were included and their case records were evaluated for clinical and laboratory records as well as diagnosis and outcomes. Results: Out of 54 neonates, 30(55%) were males and 24(45%) females. 28 (51%) were full term and 26(49%) were pre term. Mode of delivery was vaginal in 32 (59%), and LSCS in 22 (41%). Clinical features suggestive of sepsis were present in Twenty-eight neonates (52%). Fever was the most common symptom seen in 13(46%) neonates followed by poor feeding in 9 neonates and tachypnoea in two neonates. C- reactive protein was positive in 20 (37%) neonates with a mean CRP value being 30 mg/dl. from which 14 (70%) had clinical signs. Twelve (22%) neonates required NICU admission and culturepositive sepsis was seen in ve (9%) neonates. E. coli was isolated in three neonates while Acinetobacter baumanii in two. Only one neonate succumbed. Conclusion: Conrmed sepsis was seen in a very low proportion of neonates born to mothers with prolonged rupture of membranes. Hence early sepsis screening and follow-up of neonates with clinical features suggestive of sepsis might decrease the use of prophylactic antibiotics.

Factors associated with early onset neonatal sepsis among neonates in public hospitals of Sidama region, Southern Ethiopia, 2021: Unmatched case control study

BackgroundIn Ethiopia, more than one-third of all neonatal mortality are caused by early-onset neonatal sepsis, which is one of the most common reasons for neonatal hospitalization and mortality in developing countries. This study aims to add to the body of knowledge on the determinants of early-onset neonatal sepsis to reduce the prevalence of early-onset neonatal sepsis in the study setting. MethodsAn unmatched case-control study was carried out in public hospitals of Sidama region, Southern Ethiopia. The data was entered into Epi info version 7.2 and analyzed with the Statistical Package for Social Sciences version 25. Binary logistic regression was used to identify the determinants of early-onset neonatal sepsis, and variables in the multivariable logistic regression analysis with a p-value of less than 0.05 were declared significantly associated at a 95% confidence interval. ResultsIn this study, 97 neonates with early-onset neonatal sepsis (cases) and 194 neonates without early-onset neonatal sepsis (controls) were included with their index mothers. Early-onset neonatal sepsis was significantly associated with frequency of antenatal care follow-ups (AOR = 0.15, 95% CI: 0.06–0.37), instrumental delivery/assisted vaginal delivery (AOR = 3.35, 95% CI: 1.08–10.44), gestational hypertension (AOR = 2.85, 95% CI: 1.21–6.71), and Apgar score at the fifth minute (AOR = 3.13, 95% CI: 1.23–7.92). Conclusionsand recommendation: It is better to intervene on those identified factors. Strengthening antenatal care services by giving adequate information to mothers and counseling about the necessity of implementing the World Health Organization's 2016 antenatal care (ANC) recommendations for a positive pregnancy experience to prevent early-onset newborn sepsis.

Incidence of Early and Late Onset Neonatal Sepsis in Suriname: A National Tertiary Hospital Birth-cohort Study.

Early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS) are important causes of neonatal mortality and morbidity. A pressing need for reliable and detailed data of low- and middle-income countries exists. This study aimed to describe the incidence and outcome of neonatal sepsis in the only tertiary hospital of Suriname, a middle-income country in South America. Infants born at the Academic Hospital of Paramaribo from May 2017 through December 2018 were prospectively included at birth. Perinatal data, duration of antibiotic treatment, blood culture results and mortality data were gathered. Neonatal sepsis was defined as positive blood culture with a pathogenic microorganism within the first 28 days of life. Of the 2190 infants included, 483 (22%) were admitted to neonatal (intensive) care. The incidence of EONS was 2.1 (95% CI: 0.9-5) per 1000 live births, with no deaths. Antibiotics for suspected EONS were administrated to 189 (8.6%) infants, of whom 155 (82%) were born prematurely. The incidence of LONS cases was 145 (95% CI: 114-176) per 1000 admissions. Gramnegative bacteria accounted for 70% (48 out of 70) of causative organisms. Seventeen deaths were directly caused by sepsis (35 per 1000 admissions). Findings from this tertiary center birth cohort study in a middle-income setting indicate EONS incidence and outcomes comparable to high-income settings, whereas LONS is a more prevalent and significant challenge with a predominance of gram-negative bacteria, and high mortality.

Mean platelet volume and immature platelet fraction as predictors of early onset neonatal sepsis risk in neonates of 28-36 weeks gestational age

Background Early onset neonatal sepsis is a potential life-threatening problem for preterm infant. Diagnosing early onset neonatal sepsis is challenging. Difficulties in establishing diagnosis might cause delay definitive treatment.
 Objective To analyze for potential associations between early onset neonatal sepsis (EONS) risk and mean platelet volume (MPV) as well as immature platelet fraction (IPF) in neonates of 28-36 weeks gestational age.
 Methods A prospective cohort study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, West Java. Mean platelet volume (MPV) and IPF were evaluated in the first ?6 hours of life and during the 48-72 hours after the first examination. This examination was followed by observation for sepsis development. Double logistic regression analysis was used.
 Results Of 115 subjects, 45 preterm infants (39.1%) developed early onset neonatal sepsis. The increase in both mean MPV and mean IPF were significantly different (P<0.05). Double logistic regression analysis revealed that an increase in mean MPV (ORadj=6.14; 95%CI 1.99 to 18.96; P=0.002) and mean IPF (ORadj=6.56; 95%CI 2.64 to 16.34; P<0.001) were significantly associated with increased risk of sepsis.
 Conclusion The MPV and IPF increase are associated with greater incidence of EONS in preterm infants.

Mean platelet volume and immature platelet fraction as predictors of early onset neonatal sepsis risk in neonates of 28-36 weeks gestational age

Background Early onset neonatal sepsis is a potential life-threatening problem for preterm infant. Diagnosing early onset neonatal sepsis is challenging. Difficulties in establishing diagnosis might cause delay definitive treatment.
 Objective To analyze for potential associations between early onset neonatal sepsis (EONS) risk and mean platelet volume (MPV) as well as immature platelet fraction (IPF) in neonates of 28-36 weeks gestational age.
 Methods A prospective cohort study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, West Java. Mean platelet volume (MPV) and IPF were evaluated in the first ?6 hours of life and during the 48-72 hours after the first examination. This examination was followed by observation for sepsis development. Double logistic regression analysis was used.
 Results Of 115 subjects, 45 preterm infants (39.1%) developed early onset neonatal sepsis. The increase in both mean MPV and mean IPF were significantly different (P<0.05). Double logistic regression analysis revealed that an increase in mean MPV (ORadj=6.14; 95%CI 1.99 to 18.96; P=0.002) and mean IPF (ORadj=6.56; 95%CI 2.64 to 16.34; P<0.001) were significantly associated with increased risk of sepsis.
 Conclusion The MPV and IPF increase are associated with greater incidence of EONS in preterm infants.

2017 French health authority guidelines for neonates at risk of early-onset sepsis: Adherence and barriers in a tertiary hospital

The objective of this study was to evaluate the adherence to the French Health Authority's 2017 guidelines concerning early-onset sepsis (EOS) in neonates. This 6-month prospective observational study was conducted in 2020 in a tertiary hospital maternity unit. Neonates were classified according to their risk of EOS and the level of appropriate surveillance was analyzed. The risk of EOS was determined for 69.9% of the 1024 included neonates. Of the 123 neonates with a moderate or high risk of EOS, the optimal clinical surveillance was 88%. Even in a tertiary hospital, with training of caregivers, adherence to guidelines was incomplete. Some corrective measures are suggested and should be applied to enhance the adherence.

Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds.

ABSTRACTImportanceEffective screening strategies for early‐onset neonatal sepsis (EONS) have the potential to reduce high volume parenteral antibiotics (PAb) usage in neonates.ObjectiveTo compare management decisions for EONS, between CG149 National Institute for Health and Care Excellence (NICE) guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator (SRC) in a level 2 neonatal unit at a district general hospital (DGH).MethodsHospital records were reviewed for maternal and neonatal risk factors for EONS, neonatal clinical examination findings, and microbial culture results for all neonates born at ≥34 weeks’ gestation between February and July 2019, who were (1) managed according to CG149‐NICE guidelines or (2) received PAb within 72 h following birth at a DGH in Winchester, UK. SRC projections were obtained using its virtual risk estimator.ResultsSixty infants received PAb within the first 72 h of birth during the study period. Of these, 19 (31.7%) met SRC criteria for antibiotics; 20 (33.3%) met the criteria for enhanced observations and none had culture‐proven sepsis. Based on SRC projections, neonates with ‘≥1 NICE clinical indicator and ≥1 risk factor' were most likely to have a sepsis risk score (SRS) >3. Birth below 37 weeks’ gestation (risk ratio [RR] = 2.31, 95% confidence interval [CI]: 1.02–5.22) and prolonged rupture of membranes (RR = 3.14, 95% CI: 1.16–8.48) increased the risk of an SRS >3.InterpretationScreening for EONS on the SRC could potentially reduce PAb usage by 68% in term and near‐term neonates in level 2 neonatal units.

Epidemiological evolution of early-onset neonatal sepsis over 12 years: A single center, population-based study in central Taiwan.

We aimed to explore the epidemiology and evolution of pathogens, antibiotic susceptibility, and mortality rate in cases of neonatal early-onset sepsis (EOS) reported over a period of 12 years in a level III neonatal center in Central Taiwan. Patients' medical records in a neonatal center from 2007 to 2018 were reviewed to obtain information on infants with culture-proven EOS, which included pathogens found in the blood or cerebrospinal fluid cultures. The incidence of neonatal EOS during this period was 2.11 cases/1,000 admissions. Group B streptococcal (GBS) and Escherichia coli were the most common pathogens. The overall rates of GBS and E. coli infections were 0.68/1,000 and 0.77/1,000 live births, respectively. The incidence of EOS in infants with a birth weight ≥1,500 g decreased significantly with decreasing incidence of GBS-related sepsis. The incidence of EOS remained high in very-low-birth-weight (VLBW) infants and increased over time. There was an increasing trend in of E. coli infection and emergence of drug-resistant strains. In addition, E. coli sepsis had high mortality in VLBW infants. Novel screening and prevention strategies against E. coli and reserving broad-spectrum antibiotics for the most critically ill or VLBW patients with maternal chorioamnionitis might help in early diagnosis and further improve the outcomes of EOS.

COVID-19 Infection in Parturients: Comparative Neonatal and Maternal Outcomes in a Single-Institute Regional Hospital in Thailand

Objective: Chonburi province is ranked fourth in Thailand in terms of COVID-19 cases. The objective was to compare neonatal and maternal outcomes among pregnant women with and without COVID-19 infection delivered in Chonburi hospital. Materials and Methods: The present study was a retrospective matched cohort study that included all pregnant women who delivered between January 1 and August 31, 2021, at Chonburi Hospital, Thailand. The exposure group comprised women with a current or previous positive COVID-19 PCR test, while the comparators were the PCR negative group. The matching ratio was 1:4, based on gestational and maternal age, parity, and the closest delivery date. Clinical data were obtained from medical records. Results: Forty-six pregnant women had a positive COVID-19 PCR, 24 (52.17%) were Thai and 22 (47.83%) were of other ethnicities. Most (60.87%) were asymptomatic or required no medical assistance. Three (6.52%) had severe pneumonia and required respiratory support. Neither maternal death nor vertical transmission was detected. Compared with 184 COVID-19-negative pregnant women, no significant differences in low APGAR score of less than 7, and preeclampsia in the 46 COVID-19-positive pregnant women were observed. However, COVID-19-positive pregnant women showed an increased rate of neonatal respiratory distress (RD) (relative risk [RR] 2.55; 95% confidence interval [CI] 1.04 to 6.21] and clinical early-onset neonatal sepsis (RR 3.60; 1.55 to 8.36). Additionally, a higher cesarean section rate was observed in the COVID-19 positive group (RR 1.45, 1.11 to 1.85). Conclusion: There were no significant differences in neonates with APGAR of less than 7 between the cohort of 46 pregnant women who tested positive for COVID-19 and those who tested negative. However, a higher rate of cesarean delivery, presumed early-onset neonatal septicemia, and RD in the COVID-19 positive group were noted and should be monitored. Keywords: COVID-19; Pregnancy; Neonatal outcome; Birth asphyxia

A study of elevated red cell distribution width (RDW) in early-onset neonatal sepsis

BackgroundNeonatal sepsis is a serious infection occurring within the first 28 days of life. It is a significant cause of mortality and morbidity. Red cell distribution width (RDW) is estimated within the standard CBC profile and considered a simple tool for the diagnosis of neonatal sepsis without additional cost. Our aim in this study is to investigate the potential role of red cell distribution width (RDW) in the diagnosis of early-onset neonatal sepsis (EONS). The aim of our study is to detect the role of red cell distribution width (RDW) in the diagnosis and prognosis of early-onset neonatal sepsis (EONS).ResultsThis case-control study was conducted at the NICU of Beni-Suef University Hospital and revealed that RDW% was highly significantly higher among cases than among controls (16.65 ± 4.28, 11.13 ± 0.62, respectively); regarding the severity of neonatal sepsis, we divided our cases into three groups (sepsis group includes 21 neonates, severe sepsis group includes 31 neonates, and septic shock group includes 48 neonates), there were statistically significant differences between the three groups (sepsis, severe sepsis, and septic shock) regarding RDW (15.15 ± 1.65, 16.78 ± 2.01, 17.02 ± 2.02, respectively) as P value (0.027).ConclusionThis study revealed that RDW is associated with the diagnosis and prognosis of early-onset neonatal sepsis, so further study is needed to prove causation as it is being simple, less expensive, available, and easily repeated as it is routinely done with CBC, so it will be a good indicator for prognosis of neonatal sepsis.

Prevalence and presentation of neonatal sepsis at a paediatric emergency department in Johannesburg, South Africa.

BackgroundDespite a significant reduction in the prevalence of neonatal sepsis over the past three decades, the prevalence still remains high, especially in low- and middle-income countries. The aim of this study was to determine the prevalence and presenting features of neonatal sepsis at a paediatric emergency centre (PEC).MethodsMedical records of all neonates presenting to an academic hospital PEC over a six-month period were analysed. Data was compared between neonates with and without sepsis. The odds ratio was calculated to determine factors associated with neonatal sepsis.ResultsOf the 210 neonates who were included, 43 (20.5%) were diagnosed with neonatal sepsis. Of these, 19 (44.2%) presented within the first 72 hours of life (early-onset neonatal sepsis) and 4 (9.3%) died prior to hospital discharge. A history of maternal employment (odds ratio (OR) 2.38, p=0.021), preterm birth (OR 3.24, p=0.019), low birth weight (<2.5kg) (OR 2.67, p=0.026), perinatal human immunodeficiency virus exposure (OR 3.35, p=0.002), not being breast fed (OR 4.36, p=0.001), and signs of lethargy (OR 14.01, p<0.001), dehydration (or 11.14, p<0.001), poor feeding (OR 7.20, p<0.001), irritability (OR 6.93, p<0.001), fever (OR 5.50, p<0.001), vomiting (OR 4.14, p<0.001) and respiratory distress (OR 4.12, p<0.001) were significantly associated with neonatal sepsis.ConclusionAmong neonates presenting to the PEC, various clinical features on history and examination may be useful in predicting the diagnosis of neonatal sepsis. Clinicians working in the PEC must adopt a high index of suspicion when attending to neonates presenting with these features.

A retrospective study of risk factors for early-onset neonatal sepsis with intrapartum maternal fever.

BackgroundIntrapartum fever is a well-known risk factor for adverse perinatal outcomes. In this study, we evaluated the clinical features for intrapartum maternal fever and investigated the risk factors for neonatal early-onset sepsis (EOS) with intrapartum maternal fever.MethodsThis retrospective cohort study involved a total of 568 neonates born to mothers with intrapartum maternal fever (temperature peak ≥38 degree Celsius) in Hangzhou Women’s Hospital from January 1st to December 31st, 2019. Neonates were assigned to the EOS and non-sepsis groups based on the diagnostic criteria for early-onset neonatal sepsis,. Demographic data, clinical information and laboratory test results were evaluated to assess the risk factors for EOS.ResultsA total of 568 neonates were included in this study, 84 of whom were diagnosed with EOS. The EOS group was significantly different from the non-sepsis group in 11 items including the both white blood cell (WBC) count and C-reactive protein (CRP) level of the mother before delivery (p < 0.05). A logistic regression analysis revealed that a high maternal WBC count before delivery (OR = 3.261, p = 0.019) and a maternal histological chorioamnionitis (HCA) diagnosis (OR = 5.608, p = 0.002) were independent risk factors for EOS. The optimal cut-off value for WBC (before delivery) was 16.75 × 10*9/L for EOS, according to receiver operating characteristic analysis (area under curve was 0.821).ConclusionsElevated prenatal maternal WBC counts and maternal HCA diagnosis are both independently associated with EOS. Prenatal maternal WBC counts can be used as a sensitive indicator to predict EOS early.

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment.

Current neonatal early-onset sepsis (EOS) guidelines lack consensus. Recent studies suggest three different options for EOS risk assessment among infants born ≥35 wks gestational age (GA), leading to different behaviors in the sepsis workup and antibiotic administration. A broad disparity in clinical practice is found in Neonatal Units, with a large number of non-infected newborns evaluated and treated for EOS. Broad spectrum antibiotics in early life may induce different short- and long-term adverse effects, longer hospitalization, and early mother-child separation. In this single-center prospective study, a total of 3002 neonates born in three periods between 2016 and 2020 were studied, and three different workup algorithms were compared: the first one was based on the categorical risk assessment; the second one was based on a Serial Physical Examination (SPE) strategy for infants with EOS risk factors; the third one associated an informatic tool (Neonatal EOS calculator) with a universal extension of the SPE strategy. The main objective of this study was to reduce the number of neonatal sepsis workups and the rate of antibiotic administration and favor rooming-in and mother–infant bonding without increasing the risk of sepsis and mortality. The combined strategy of universal SPE with the EOS Calculator showed a significant reduction of laboratory tests (from 33% to 6.6%; p < 0.01) and antibiotic treatments (from 8.5% to 1.4%; p < 0.01) in term and near-term newborns. EOS and mortality did not change significantly during the study period.