Incidence Of Neonatal Sepsis Research Articles

Mosapride combined with probiotics on gastrointestinal function and growth in premature infants.

The aim of this study was to investigate the effects of mosapride combined with probiotics on gastrointestinal function and growth and development in premature infants. A total of 240 premature infants treated at Weifang People's Hospital between June 2012 and May 2015 who matched our criteria were randomly divided into three groups of 80 cases each. Group A received routine treatment, group B received routine treatment combined with live B. subtilis and E. faecium granules with multivitamins (Medilac-Vita), and group C received routine treatment and Saccharomyces boulardii sachets (Bioflor). Mosapride was administered to patients in groups B and C to promote intestinal peristalsis. Gastrin and bilirubin levels, as well as jaundice fade time, were recorded. Growth and development condition (i.e., head circumference and weight), duration and incidence of feeding intolerance (FI), as well as other symptoms were also analyzed. By day 14, gastrin concentrations in groups B and C were significantly higher than those in group A (P<0.05). Serum bilirubin levels in groups B and C showed a progressive decline from day 7 to day 14, and jaundice duration in group A was significantly longer (P<0.05). Furthermore, at 2 weeks, the average weight growth rate and head circumference were significantly greater in groups B and C, weight loss recovery time was shorter, and EUGR incidence was lower (P<0.05). The incidence rate of gastric retention and FI were lower in groups B and C than group A (P<0.05), and neonatal hyperbilirubinemia, parenteral nutrition-associated cholestasis, necrotizing enterocolitis, and neonatal sepsis incidence was significantly lower in groups B and C (P<0.05). Mosapride combined with probiotics can effectively reduce FI incidence in premature infants, shorten enteral feeding time, promote the absorption of required nutrients, and promote the development and recovery of early physiological weight loss in preterm infants.

Innate Immunity and Human Milk MicroRNAs Content: A New Perspective for Premature Newborns

Context: The premature newborns are prone to develop both early onset and late onset neonatal sepsis. The major causes of this phenomenon rely on the immaturity of the immune system, which has reduced capability to respond adequately to pathogens. Evidence Acquisition: Titles and abstracts of previous papers were scanned before reading the full-text, in order to retrieve appropriate information. The databases used for searching were PubMed, Cochrane, and Embase for articles published before 1st of July, 2016. Secondary search for articles cited in reference lists were identified by the primary search. This review focused on neonatal sepsis incidence and the associated immune response with regards to microRNAs of human milk as a new microelement that enables regulation of innate immunity functions. Results: Since human milk is a valuable source of microRNAs, a better understanding of its content will open a new therapeutic avenue for the clinical management of infectious diseases affecting premature newborns. The variation in miRNAs quantity in human milk needs to be considered. Mother’s milk can have different amounts of miRNAs and the identification of a microMilk batch richer of miRNAs can be a nutrition intervention method for modulating innate immunity in clinical management of premature newborns. Conclusions: Routine translation of the microMilk concept for neonatal intensive care unit (NICU), in the management of premature newborns could be a way of defending premature newborns and Very Low Birth Weight (VLBW) infants from both early and late sepsis.

Role of hematological scoring system in diagnosis of neonatal sepsis

Background: Neonatal sepsis is one of the major causes of morbidity and mortality in the newborn, more so in the developing countries. The incidence of neonatal sepsis has been reported to be 30/1000 live births according to National Neonatal Perinatal Database. Objectives: To analyze the diagnostic utility of hematological scoring system (HSS) and its correlation with C-reactive protein and blood culture in neonatal sepsis. Materials and Methods: This prospective study included 150 neonates admitted to Neonatal Intensive Care Unit with clinical suspicion of neonatal sepsis from November 2012 to April 2014, considering the inclusion and exclusion criteria. Results: HSS had the highest sensitivity (93.7%) and identified >90% of neonates with clinical suspicion of sepsis. Furthermore, total leukocyte count showed high specificity but least sensitivity, immature to total ratio and immature to mature ratio showed high specificity and high sensitivity, and platelet count showed high negative predictive value and least positive predictive value. Conclusion: HSS is a simple, easy, cheap, and rapid adjunct for the diagnosis of clinically suspected cases of neonatal sepsis.

Outcome of newborns born to mothers with prolonged rupture of membrane

Introduction: Prolonged rupture of membrane (PROM) is an important risk factor for early onset neonatal sepsis (EONS), which is associated with increased neonatal morbidity and mortality. This study is mainly done to know the outcome of neonates born to mothers with history of PROM. Methods: This study was conducted from January 2015 to December 2015 for a period of 12 months, in GSL medical college and hospital, Rajahmundry. Selection of cases-All the neonates born to mothers with history of prolonged rupture of membranes >18hrs were included in our study. Required investigations were done and followed during their hospital stay. Results: Out of 200 neonates born to mothers with PROM, 60 had clinical sepsis, 29 had confirmed sepsis. Out of 29 confirmed cases of sepsis, positive blood culture was seen in 22 cases. The incidence of EONS in present study was found to be 14.5%. In present study neonatal sepsis had a higher rate of incidence in preterm neonates (61.5%) than in term neonates (38.5%). The incidence of neonatal sepsis was found to be lower in neonates born to mothers who took prenatal antibiotic treatment (9.25%) as compared to neonates born to mothers who did not receive prenatal antibiotic treatment (20.65%). Respiratory distress was the commonest presenting clinical sign (33 cases). Out of all the five Sepsis screen parameters C-Reactive Protein has the highest sensitivity (90.90%). Conclusion: Preventive measures should focus on recognition of these high-risk infants with prompt laboratory screening for sepsis and early institution of empirical antibiotic based on local data

HUBUNGAN ANTARA MASA GESTASI DAN KEJADIAN SEPSIS NEONATORUM DI RSUD ULIN BANJARMASIN PERIODE JUNI 2014-JUNI 2015

Abstract: Neonatal sepsis is a clinical syndrome characterized by symptoms of bacteremia and systemic signs and positive blood cultures showed that during the first month of life. Prematurity and postmaturity risk of morbidity and mortality are high on the gestation age for the occurrence of neonatal sepsis. This study aims to determine the relationship between gestational age and the incidence of neonatal sepsis in Ulin Hospital Banjarmasin. The design of this study using cross sectional study with retrospective approach. The way the sampling is the purposive sampling were obtained from medical records of patients, then performed statistical analysis using chi-square test with 95%. The number of samples that fulfilled the criteria inclusion in this study as many as 246 cases. The incidence of neonatal sepsis is more common in infants born at 37-42 weeks gestation as many as 25 cases (59.52%). The data not neonatal sepsis who were born with a gestational age &lt;37 weeks or&gt; 42 weeks gained as many as 20 cases (9.80%) and 37-42 weeks gestation obtained as many as 184 cases (90.20%). Chi-square test showed that there is a relationship between gestational age and the incidence of neonatal sepsis in Ulin Hospital Banjarmasin (p = 0.000) with an odds ratio (OR) 6.256. It is concluded that there is a relationship of gestation age and the incidence of neonatal sepsis (p &lt;0.05) in hospitals Ulin Banjarmasin period June 2014-June 2015 with OR 6.256. Keywords: gestational age, sepsis, neonatal Abstrak: Sepsis neonatorum merupakan suatu sindrom klinis bakteremia yang ditandai dengan gejala dan tanda sistemik serta menunjukkan kultur darah positif yang terjadi pada bulan pertama kehidupan. Prematuritas dan posmaturitas memiliki risiko kesakitan dan kematian yang tinggi pada masa gestasi untuk terjadinya sepsis neonatorum. Penelitian ini bertujuan untuk mengetahui hubungan antara masa gestasi dan kejadian sepsis neonatorum di RSUD Ulin Banjarmasin. Rancangan penelitian ini menggunakan cross sectional study dengan pendekatan retrospektif. Cara pengambilan sampel yaitu dengan purposive sampling yang diperoleh dari data rekam medis pasien, kemudian dilakukan analisis statistik menggunakan uji chi-square dengan kepercayaan 95%. Jumlah sampel yang memenuhi kriteria inklusi dalam penelitian ini sebanyak 246 kasus. Kejadian sepsis neonatorum lebih banyak dijumpai pada bayi yang lahir dengan masa gestasi 37-42 minggu yaitu sebanyak 25 kasus (59,52%). Data neonatus tidak sepsis yang lahir dengan masa gestasi &lt;37 minggu atau &gt;42 minggu didapatkan sebanyak 20 kasus (9,80%) dan masa gestasi 37-42 minggu didapatkan sebanyak 184 kasus (90,20%). Uji chi square menunjukkan bahwa terdapat hubungan antara masa gestasi dan kejadian sepsis neonatorum di RSUD Ulin Banjarmasin (p=0,000) dengan odds ratio (OR) 6,256. Kesimpulan penelitian ini adalah terdapat hubungan masa gestasi dan kejadian sepsis neonatorum (p&lt;0,05) di RSUD Ulin Banjarmasin periode Juni 2014-Juni 2015 dengan OR 6,256. Kata-kata kunci: masa gestasi, sepsis, neonatus

Multidrug - Resistant Acinetobacter Species Infection among Neonates

Background: Multidrug resistant Acinetobacter infection has emerged as an important pathogen in neonatal sepsis in the recent years causing morbidity as well as mortality. Methods: Neonates admitted with sepsis in NICU from Jan 2014 to Dec.2014 were retrospectively analysed to find out the incidence, clinical features, antibiotic sensitivity pattern and the risk factors associated with mortality in culture positive Acinetobacter sepsis. Results: Incidence of neonatal sepsis was 11.3% (26/230).Neonatal sepsis caused by Acinetobacter spp was 5.65% (13/230). Pure growth of Acinetobacter was obtained in 13 and all of them were multidrug resistant. Resistance to Meropenem was 50%.Out of 13, six were early onset and seven were late onset sepsis. The major signs were poor perfusion (9/13), hypotension (9/13) and respiratory distress (13/13). Mortality due to Acinetobacter neonatal sepsis was 76.92% (10/13 ).The major risk factors associated with death in Acinetobacter sepsis were female sex, prematurity (<30 weeks) , birth weight less than 1500 gm and normal deliveries. Conclusion: Multidrug resistant Acinetobacter infection is fatal, particularly in premature and very low birth weight neonates.

Sealing procedures for preterm prelabour rupture of membranes

Preterm prelabour rupture of the membranes (PPROM) complicates approximately 2% of pregnancies and can be either spontaneous or iatrogenic in nature. Complications of PPROM include prematurity, chorioamnionitis, neonatal sepsis, limb position defects, respiratory distress syndrome, pulmonary hypoplasia chronic lung disease, periventricular leukomalacia and intraventricular haemorrhage.A number of different sealing techniques have been employed which aim to restore a physical barrier against infection and encourage the re-accumulation of amniotic fluid. Routine use of sealants is currently not recommended due to a lack of sufficient evidence to support the safety and effectiveness of such interventions. To assess the effects of sealing techniques following PPROM against each other, or versus standard care (including no sealant), on maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies. Randomised and quasi-randomised controlled trials comparing different techniques for sealing preterm prelabour ruptured membranes. Cluster-randomised trials and trials using a cross-over design were not eligible for inclusion in this review. We planned to include abstracts when sufficient information was provided. Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. We included two studies (involving 141 women - with data from 124 women). We considered both studies as being at high risk of bias. Meta-analysis was not possible because the included studies examined different interventions (both in comparison with standard care) and reported on few, but different, outcomes. One study compared cervical adapter (mechanical sealing), and the other study examined an immunological membrane sealant. Neither of the included studies reported on this review's primary outcome of interest - perinatal mortality. Similarly, data were not reported for the majority of this review's secondary infant and maternal outcomes. Cervical adapter (mechanical sealing) versus standard care (one study, data from 35 participants)No data were reported for this review's primary outcome - perinatal mortality. Data were reported for few of this review's infant or maternal secondary outcomes.There was no clear difference between the mechanical sealing group and the standard care control in relation to the incidence of neonatal sepsis (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.28 to 5.09 (very low-quality evidence)) or chorioamnionitis (RR 1.19, 95% CI 0.28 to 5.09 (very low-quality evidence)). Oral immunological membrane sealant versus standard care (one study, data from 94 participants)No data were available for perinatal mortality (this review's primary outcome) or for the majority of this review's infant and maternal secondary outcomes. Compared to standard care, the immunological membrane sealant was associated with a reduction in preterm birth less than 37 weeks (RR 0.48, 95% CI 0.34 to 0.68 (very low-quality evidence)) and a reduction in neonatal death (RR 0.38, 95% CI 0.19 to 0.75 (very low-quality evidence)). However, there was no clear difference between groups in terms of neonatal sepsis (RR 0.64, 95% CI 0.28 to 1.46 (very low-quality evidence)) or respiratory distress syndrome (RR 0.64, 95% CI 0.28 to 1.46 (very low-quality evidence)). There is insufficient evidence to evaluate sealing procedures for PPROM. There were no data relating to this review's primary outcome (perinatal mortality) and the majority of our infant and maternal secondary outcomes were not reported in the two included studies.There was limited evidence to suggest that an immunological membrane sealant was associated with a reduction in preterm birth at less than 37 weeks and neonatal death, but these results should be interpreted with caution as this is based on one small study, with a high risk of bias, and the intervention has not been tested in other studies.Although midtrimester PPROM is not a rare occurrence, there are only a small amount of published data addressing the benefits and risks of sealing procedures. Most of these studies are retrospective and cohort based and could therefore not be included in our data-analysis.This review highlights the paucity of prospective randomised trials in this area. Current evidence provides limited information both on effectiveness and safety for the interventions described. Given the paucity of high-quality data, we recommend that future research efforts focus on the conduct of randomised trials assessing the effect of promising interventions that have been only evaluated to date in cohort studies (e.g. amniopatch). Future trials should address outcomes including perinatal mortality, preterm birth, neonatal death, respiratory distress syndrome, neonatal sepsis and developmental delay. They should also evaluate maternal outcomes including sepsis, mode of delivery, length of hospital stay and emotional well-being.

Umbilical cord cleansing with chlorhexidine in neonates: a systematic review

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of chlorhexidine application to the umbilical cord in neonates. We searched MEDLINE and other electronic databases, and included all RCTs that evaluated the effect of single or multiple chlorhexidine cord applications on the neonatal mortality rate (NMR) and/or the incidence of systemic sepsis and omphalitis. A total of six RCTs—four community-based cluster RCTs and two hospital-based trials—were included in the review. Of the four cluster RCTs, three were conducted in South Asia in settings with high rates of home births (>92%) while the fourth, available only as an abstract, was conducted in Africa. Pooled analysis by the ‘intention-to-treat' principle showed a significant reduction in NMR after chlorhexidine application (four studies; relative risk (RR) 0.85; 95% confidence interval (CI) 0.76 to 0.95; fixed effects (FE) model). On subgroup analysis, only multiple applications showed a significant effect (four studies; RR 0.88; 95% CI 0.78 to 0.99) whereas a single application did not (one study; RR 0.86; 0.73 to 1.02). Similarly, only the community-based trials showed a significant reduction in NMR (three studies; RR 0.86; 95% CI 0.77 to 0.95), while the hospital-based study did not find any effect (RR 0.11; 0.01 to 2.03). Since all the studies were conducted in high-NMR settings (⩾30 per 1000 live births), we could not determine the effect in settings with low NMRs. Only one study—a hospital-based trial from India—reported the incidence of neonatal sepsis; it did not find a significant reduction in any sepsis (RR 0.67; 95% CI 0.35 to 1.28). Pooled analysis of community-based studies revealed significant reduction in the risk of omphalitis in infants who received the intervention (four studies; RR 0.71; 95% CI 0.62 to 0.81). The hospital-based trial had no instances of omphalitis in either of the two groups. Chlorhexidine application delayed the time to cord separation (four studies; mean difference 2.11 days; 95% CI 2.07 to 2.15; FE model). Chlorhexidine application to the cord reduces the risk of neonatal mortality and omphalitis in infants born at home in high-NMR settings. Routine chlorhexidine application, preferably daily for 7 to 10 days after birth, should therefore be recommended in these infants. Given the paucity of evidence, there is presently no justification for recommending this intervention in infants born in health facilities and/or low-NMR settings.

Immediate Delivery Compared With Expectant Management After Preterm Pre-labour Rupture of the Membranes Close to Term (PPROMT Trial)

Summary Background Preterm pre-labour ruptured membranes close to term is associated with increased risk of neonatal infection, but immediate delivery is associated with risks of prematurity. The balance of risks is unclear. We aimed to establish whether immediate birth in singleton pregnancies with ruptured membranes close to term reduces neonatal infection without increasing other morbidity. Methods The PPROMT trial was a multicentre randomised controlled trial done at 65 centres across 11 countries. Women aged over 16 years with singleton pregnancies and ruptured membranes before the onset of labour between 34 weeks and 36 weeks and 6 days weeks who had no signs of infection were included. Women were randomly assigned (1:1) by a computer-generated randomisation schedule with variable block sizes, stratified by centre, to immediate delivery or expectant management. The primary outcome was the incidence of neonatal sepsis. Secondary infant outcomes included a composite neonatal morbidity and mortality indicator (ie, sepsis, mechanical ventilation ≥24 h, stillbirth, or neonatal death); respiratory distress syndrome; any mechanical ventilation; and duration of stay in a neonatal intensive or special care unit. Secondary maternal outcomes included antepartum or intrapartum haemorrhage, intrapartum fever, postpartum treatment with antibiotics, and mode of delivery. Women and caregivers could not be masked, but those adjudicating on the primary outcome were masked to group allocation. Analyses were by intention to treat. This trial is registered with the International Clinical Trials Registry, number ISRCTN44485060. Findings Between May 28, 2004, and June 30, 2013, 1839 women were recruited and randomly assigned: 924 to the immediate birth group and 915 to the expectant management group. One woman in the immediate birth group and three in the expectant group were excluded from the primary analyses. Neonatal sepsis occurred in 23 (2%) of 923 neonates whose mothers were assigned to immediate birth and 29 (3%) of 912 neonates of mothers assigned to expectant management (relative risk [RR] 0·8, 95% CI 0·5–1·3; p=0·37). The composite secondary outcome of neonatal morbidity and mortality occurred in 73 (8%) of 923 neonates of mothers assigned to immediate delivery and 61 (7%) of 911 neonates of mothers assigned to expectant management (RR 1·2, 95% CI 0·9–1·6; p=0·32). However, neonates born to mothers in the immediate delivery group had increased rates of respiratory distress (76 [8%] of 919 vs 47 [5%] of 910, RR 1·6, 95% CI 1·1–2·30; p=0·008) and any mechanical ventilation (114 [12%] of 923 vs 83 [9%] of 912, RR 1·4, 95% CI 1·0–1·8; p=0·02) and spent more time in intensive care (median 4·0 days [IQR 0·0–10·0] vs 2·0 days [0·0–7·0]; p Interpretation In the absence of overt signs of infection or fetal compromise, a policy of expectant management with appropriate surveillance of maternal and fetal wellbeing should be followed in pregnant women who present with ruptured membranes close to term. Funding Australian National Health and Medical Research Council, the Women's and Children's Hospital Foundation, and The University of Sydney.

Clinical and Bacteriological Profile of Neonatal Sepsis in King Khaleed Civilian Hospital, Tabuk, Kingdom of Saudi Arabia

Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 28 days of life. Of newborns with early-onset sepsis, 85% present within 24 hours, 5% present at 24-48 hours, and a smaller percentage present within 48-72 hours. The present study included 38 septic neonates. They were divided into two groups: Group with early onset neonatal sepsis (29) and another group with late onset neonatal sepsis (9). The study group with early-onset sepsis showed 18 (62.1%) males, 11 (37.9%) females, mean gestational age (weeks) 34.28±4.7, mean body weight (gm) 2.1±0.8, mean Apgar score at 1 min. 6.7±1.8. 21 (72.4%) delivered by CS, 8 (27.6%) delivered by NVD. E. coli was the commonest organism identified in blood culture of septic neonates. Maternal anemia, PROM, and fever were significant risk factors for neonatal sepsis. Prematurity and low birth weights were among the most common neonatal risk factors. Respiratory manifestations were the commonest manifestations of neonatal sepsis in both groups. Treating maternal anemia during pregnancy will help to reduce the incidence of neonatal sepsis <i>E. coli</i> is still an important cause of early-onset neonatal sepsis. Blood cultures need to be done strictly before the start of the first dose of antibiotic.

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial

Preterm pre-labour ruptured membranes close to term is associated with increased risk of neonatal infection, but immediate delivery is associated with risks of prematurity. The balance of risks is unclear. We aimed to establish whether immediate birth in singleton pregnancies with ruptured membranes close to term reduces neonatal infection without increasing other morbidity. The PPROMT trial was a multicentre randomised controlled trial done at 65 centres across 11 countries. Women aged over 16 years with singleton pregnancies and ruptured membranes before the onset of labour between 34 weeks and 36 weeks and 6 days weeks who had no signs of infection were included. Women were randomly assigned (1:1) by a computer-generated randomisation schedule with variable block sizes, stratified by centre, to immediate delivery or expectant management. The primary outcome was the incidence of neonatal sepsis. Secondary infant outcomes included a composite neonatal morbidity and mortality indicator (ie, sepsis, mechanical ventilation ≥24 h, stillbirth, or neonatal death); respiratory distress syndrome; any mechanical ventilation; and duration of stay in a neonatal intensive or special care unit. Secondary maternal outcomes included antepartum or intrapartum haemorrhage, intrapartum fever, postpartum treatment with antibiotics, and mode of delivery. Women and caregivers could not be masked, but those adjudicating on the primary outcome were masked to group allocation. Analyses were by intention to treat. This trial is registered with the International Clinical Trials Registry, number ISRCTN44485060. Between May 28, 2004, and June 30, 2013, 1839 women were recruited and randomly assigned: 924 to the immediate birth group and 915 to the expectant management group. One woman in the immediate birth group and three in the expectant group were excluded from the primary analyses. Neonatal sepsis occurred in 23 (2%) of 923 neonates whose mothers were assigned to immediate birth and 29 (3%) of 912 neonates of mothers assigned to expectant management (relative risk [RR] 0·8, 95% CI 0·5-1·3; p=0·37). The composite secondary outcome of neonatal morbidity and mortality occurred in 73 (8%) of 923 neonates of mothers assigned to immediate delivery and 61 (7%) of 911 neonates of mothers assigned to expectant management (RR 1·2, 95% CI 0·9-1·6; p=0·32). However, neonates born to mothers in the immediate delivery group had increased rates of respiratory distress (76 [8%] of 919 vs 47 [5%] of 910, RR 1·6, 95% CI 1·1-2·30; p=0·008) and any mechanical ventilation (114 [12%] of 923 vs 83 [9%] of 912, RR 1·4, 95% CI 1·0-1·8; p=0·02) and spent more time in intensive care (median 4·0 days [IQR 0·0-10·0] vs 2·0 days [0·0-7·0]; p<0·0001) compared with neonates born to mothers in the expectant management group. Compared with women assigned to the immediate delivery group, those assigned to the expectant management group had higher risks of antepartum or intrapartum haemorrhage (RR 0·6, 95% CI 0·4-0·9), intrapartum fever (0·4, 0·2-0·9), and use of postpartum antibiotics (0·8, 0·7-1·0), and longer hospital stay (p<0·0001), but a lower risk of caesarean delivery (RR 1·4, 95% CI 1·2-1·7). In the absence of overt signs of infection or fetal compromise, a policy of expectant management with appropriate surveillance of maternal and fetal wellbeing should be followed in pregnant women who present with ruptured membranes close to term. Australian National Health and Medical Research Council, the Women's and Children's Hospital Foundation, and The University of Sydney.

Neonatal sepsis in a rapidly growing, tertiary neonatal intensive care unit: Trends over 18 years

We investigated changes in the admission patterns of neonatal intensive care units and the epidemiology of neonatal sepsis following the rapid expansion and improvements in neonatal intensive care. Data on the admission of neonates with culture-proven sepsis between 1996 and 2013 (period I, 1996-2005; period II, 2006-2013) were collected retrospectively. The admission of extremely low-birthweight (ELBW) infants increased between periods I and II (11.1 vs 28.7 infants per 1000 live births, P < 0.001). The survival rate of the ELBW infants improved (57.5 vs 80.1%, P < 0.001), and duration of hospital stay increased (median, 64 vs 80 days, P = 0.001). The incidence of sepsis among all infants and ELBW infants increased (all infants, 5.9 vs 12.7 cases per 1000 live births; ELBW infants, 189.5 vs 290.1 cases per 1000 live births). In ELBW infants, the incidence of sepsis caused by coagulase-negative Staphylococcus (CONS), significantly increased during period II (8.8 vs 25.4%, P = 0.039). On multivariate analysis, central vascular catheters and prolonged hospitalization were independently associated with increased sepsis rate, particularly CONS in ELBW infants. The inborn admission rate for ELBW infants has increased significantly and is accompanied by improved survival and longer hospital stay. The incidence of neonatal sepsis, particularly in ELBW infants, has also increased, and CONS has emerged as a major pathogen. Central vascular catheters and prolonged hospitalization could be independent risk factors for the increased sepsis rate, particularly sepsis due to CONS.

Timing of Antibiotic Prophylaxis in Elective Caesarean Delivery: A Multi-Center Randomized Controlled Trial and Meta-Analysis.

ObjectiveTo compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in elective caesarean delivery.MethodsWe conducted a randomized open-label controlled trial with two parallel arms at three hospitals in western China. Participants meeting the inclusion criteria received antibiotics 30-60 minutes before skin incision while others received antibiotics after umbilical cords clamping. For the meta-analysis, studies were identified from the database of PUBMED, Cochrane Library and EMbase and assessed using the Cochrane risk of bias tool.ResultsFour hundred and ten patients were randomized to receive antibiotics before skin incision (n = 205) or after umbilical cords clamping (n = 205). There was no difference in the incidence of postpartum endometritis (RR = 0.34, 95% CI 0.04 to 3.24), wound infection (RR = 3.06, 95% CI 0.13 to 74.69) and total puerperal morbidity (RR = 1.02, 95% CI 0.47 to 2.22). No increase in the incidence of neonatal sepsis (RR = 0.34, 95% CI 0.04 to 3.24), septic workup (RR = 0.41, 95% CI 0.08 to 2.07), or intermediate NICU admission (RR = 0.73, 95% CI 0.24 to 2.26) was observed. The meta-analysis involving nine RCTs showed that no statistically significant difference was found in terms of the risk of postpartum endometritis (RR = 0.73, 95% CI 0.39, 1.36), wound infection (RR = 0.80, 95%CI 0.55, 1.17), or puerperal morbidity (RR = 0.89, 95% CI 0.70, 1.13). No increase in the incidence of neonatal sepsis (RR = 0.65, 95% CI 0.35 to 1.20), septic workup (RR = 0.88, 95% CI 0.50 to 1.54), or intermediate NICU admission (RR = 0.91, 95% CI 0.70 to 1.18) was observed.ConclusionFor elective caesarean delivery, the effects of antibiotic prophylaxis before skin incision and after umbilical cord clamping were equal. Both antibiotic prophylaxis before skin incision and that after umbilical cord clamping were recommended for elective caesarean delivery. The outcome of further studies should address both maternal and neonatal infectious morbidity as well as long-term neonatal follow up.Trial RegistrationChinese Clinical Trial Registry ChiCTR-TRC-11001853

Risk Factors for Neonatal Sepsis and Method for Reduction of Blood Culture Contamination.

False-positive blood cultures findings may lead to a falsely increased morbidity and increased hospital costs. The survey was conducted as retrospective - prospective study and included 239 preterm infants (born before 37 weeks of gestation) who were treated in Neonatal Intensive Care Unit (NICU) in Institute for Child and Youth Health Care of Vojvodina during one year (January 1st, 2012 to December 31st, 2012). The retrospective part of the study focused on examination of incidence of neonatal sepsis and determination of risk factors. In the prospective part of the study infants were sub-divided into two groups: Group 1- infants hospitalized in NICU during the first 6 months of the study; blood cultures were taken by the "clean technique" and checklists for this procedure were not taken. Group 2- neonates hospitalized in NICU during last 6 months of the study; blood cultures were taken by "sterile technique" and checklists for this procedure were taken. The main risk factors for sepsis were prelabor rupture of membranes, low gestational age, low birth weight, mechanical ventilation, umbilical venous catheter placement, and abdominal drainage. Staphylococcus aureus and coagulase negative Staphylococcus were the most frequently isolated microorganisms in false-positive blood samples. Education of employees, use of checklists and sterile sets for blood sampling, permanent control of false positive blood cultures, as well as regular and routine monthly reports are crucial for successful reduction of contamination rates.

Clinical characteristics in twin premature infants

Objective To explore the clinical characteristics in twin premature infants in order to provide some guidance for clinical work in future. Methods The clinical data of 593 premature infants hospitalized in Department of Pediatrics, the Affiliated Hospital of Kunming Medical University were collected from June 2010 to June 2012, in terms of gestational age, birth weight and neonatal complications.A retrospective analysis was performed for the data.The premature infants were divided into 2 groups: study group of 131 twin premature infants and control group of 462 singleton premature infants.The 131 twin premature infants in study group were divided into large double group(n=64) and small double group(n=67) according to delivery time.The clinical data of premature infants in each group were statistically analyzed. Results The gestational age of study group was (34.23±1.90) weeks, which in control group was (33.91±1.82) weeks, and there was no significant difference between the 2 groups(t=1.689, P=0.092). The birth weight in study group[(1 921.64±414.05)g] had statistically significant difference compared with control group[(2 164.98±495.85)g] (t=-5.209, P=0.000). The study group of incidence of premature rupture of membranes was 16.79% (22/131 cases)and which in the control group was 32.68%(151/462 cases), and there was statistically significant difference between the 2 groups(χ2 =12.472, P=0.000); the incidence of neonatal asphy-xia of study group was 9.92%(13/131 cases) and that of the control group was 17.10%(79/462 cases), there was statistically significant difference between the 2 groups(χ2=4.010, P=0.045); the incidence of respiratory distress syndrome in study group was 6.87%(9/131 cases)and that in the control group was 3.03%(14/462 cases), the difference was statistically significant between the 2 groups(χ2=4.037, P=0.045); the incidence of apnea in study group was 4.58%(6/131 cases) and that in the control group was 0.65%(3/462 cases), the difference was statistically significant between the 2 groups(χ2=8.085, P=0.004); the incidence of meconium aspiration syndrome of study group was 0 and that of the control group was 3.90%(18/462 cases), there was statistically significant difference(P=0.018); the incidence of neonatal hypoglycemia of study group was 27.48%(36/131 cases)and that of the control group was 16.67%(77/462 cases), the difference was statistically significant between the 2 groups(χ2=7.738, P=0.005); the incidence of sepsis of study group [16.79%(22/131 cases)]was significantly higher than that of the control group [8.44%(39/462 cases)], and the difference was statistically significant between the 2 groups(χ2=7.715, P=0.005); the incidence of extrauterine growth retardation of study group was 6.10%(8/131 cases) and that of the control group was 2.38%(11/462 cases), the difference was statistically significant between the both groups(χ2=4.568, P=0.033). In the study group, the incidence of neonatal sepsis in big double group was 29.68%(19/64 cases), and that in small double was 14.93%(10/67 cases), there was statistically significant difference between the 2 groups(χ2=4.138, P=0.042). The other complications between the big double group and small double group had no significant difference. Conclusions The incidence rates of acute respiratory distress syndrome, apnea, neonatal hypoglycemia, sepsis and extrauterine growth retardation of twin premature infants are higher than the singleton premature infants in the neonatal period.But the incidence rate of meconium aspiration syndrome is a higher in singleton premature infants. Key words: Twin premature infant; Singleton premature infant; Clinical characteristics

Audit of sepsis in neonatal surgeries at tertiary-care level hospital in India

Background: Postoperative sepsis, which has high morbidity and mortality, is a major problem affecting the outcome of neonatal surgeries. Adequate treatment and preventive measures for sepsis can decrease the morbidity and mortality in neonatal surgeries. Objective: (1) To study the incidence of sepsis in neonatal surgical patients and (2) To study the causative organisms and their sensitivity to antibiotics in such sepsis. Materials and Methods: A prospective, observational study was carried out in the tertiary-care level neonatal intensive care unit of SSG Hospital, Vadodara, Gujarat. Eighty newborns having a major surgery within the first 30 days of life were included in the study. Baseline data of the study participants were collected including antenatal and perinatal histories and evidence of postoperative sepsis. Complete examination and investigations including quantitative C-reactive protein (QCRP), WBC counts, blood culture, and treatment were also included. Conclusion: Incidence of postoperative sepsis in neonates was found to be 73.75%. We found coagulase-negative Staphylococcus aureus to be the most common organism (38%) cultured from blood, followed by Klebsiella (19%) and Acinetobactor (18.2%), which was sensitive to cefotaxime, amikacin, and piperacillin/tazobactam.

Risk factors of sepsis in premature infants

Introduction: Neonatal sepsis is one of the most important causes of morbidity and mortality in preterm infants. Neonatal sepsis is defined as invasive bacterial infection that occurs in newborn children from the first to the ninetieth day of life. Hemoculture still represents the gold standard for the detection of sepsis. Blood culture may be falsely positive due to contamination of the samples. Contaminated blood cultures increase treatment costs and extend the length of stay of premature babies in hospitals. The aim of the study was to determine the incidence and risk factors of sepsis in premature infants who are being treated in the intensive care. Also to determine whether preventive medical-technical procedures will reduce the incidence of neonatal sepsis, as well as a reduction in contamination hemocultures. Materials and Methods: 239 premature infants have been analysed in whom the observed risk factors can lead to the onset neonatal sepsis. The preventive actions that could lead to a reduction of contamination in hemocultures have also been analysed. Results: The most common risk factors for sepsis is a small gestational age and body weight below 2000g. By using aseptic techniques for taking hemocultures there was a significant reduction in contamination of the same. Conclusion. Statistical analysis of the data identified the most common factors that lead to the occurrence of neonatal sepsis and proved the significance of the reduction of hemoculture contamination after the introduction of aseptic procedures and check lists.

Candidemia-induced pediatric sepsis and its association with free radicals, nitric oxide, and cytokine level in host

Candida species has become the seventh most frequent causal microorganisms of nosocomial sepsis. Prematurity and low birth weights are strongly associated with the development of neonatal nosocomial bloodstream infections. Candida albicans has been the species most often associated with neonatal infections, but recently, there has been a changing pattern in the isolates recovered from neonates with invasive candidiasis, which poses resistance to the existing class of azoles such as fluconazole antifungals along with cross resistance to newer triazoles, which results in a therapeutic challenge in invasive fungal infections causing high incidence of mortality.Candida species was isolated from blood of neonates and children younger than 15 years admitted to hospital and susceptible for Candida-induced sepsis. Polymerase chain reaction–based identification and confirmation of individual Candida species were done using DNA sequencing. Antibiotic susceptibility assay and resistance pattern for fluconazole, voriconazole, and amphotericin were done for all the isolates. Furthermore, the change in free radical, cytokine release, and nitric oxide synthase expression and nitric oxide release from polymorphonuclear leukocytes isolated from control and pediatric sepsis cases were also performed.The present study probably for the first time reports the change in increasing incidence of nonalbicans Candida-induced sepsis in neonates and children admitted to the intensive care unit of hospital, and current antibiotics load posing resistance for antifungal treatment strategy and provide serious threats in future treatment. The increase in free radicals in polymorphonuclear leukocytes and increase in expression of nitric oxide synthase expression and nitric oxide release in Candida-infected pediatric sepsis cases underlie the role of host factor in dissemination and invasiveness of infection from exogenous sources and pathogenesis of systemic inflammation during sepsis.

Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections.

Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result from meconium aspiration syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity. The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014). Randomised controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We included two studies with 362 pregnant women. Both studies compared ampicillin-sulbactam (N = 183) versus normal saline (N = 179) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, there was a significant decrease in the risk of chorioamnionitis (RR 0.36, 95% CI 0.21 to 0.62). No serious adverse effects were reported. Drug resistance, duration of mechanical ventilation and duration of admission to NICU/hospital were not reported. Most of the domains for risk of bias were at low risk of bias for one study and at unclear risk of bias for the other study. The quality of the evidence using GRADE was low for neonatal sepsis, postpartum endometritis, and neonatal mortality and morbidity prior to discharge (Neonatal intensive care admissions) and of moderate quality for chorioamnionitis. Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.

PS-310 Immediate Delivery Versus Expectant Care In Women With Preterm Prelabour Rupture Of The Membranes Close To Term (ppromt): A Multi-centre Randomised Controlled Trial

<h3>Background</h3> Preterm prelabour rupture of membranes (PPROM) is the cause of 40% of all preterm births. Best practice for women who rupture their membranes preterm is not known. The aim of this study is to determine whether immediate delivery or expectant management of women with PPROM at 34–36⁶ weeks gestation is associated with less neonatal and/or maternal morbidity. <h3>Methods</h3> The PPROMT Trial is a large, international, multi-centre, randomised controlled trial with 1835 recruits from 65 centres in 11 countries. The primary study outcome is the incidence of neonatal sepsis. Secondary outcomes include severe neonatal morbidity/mortality (sepsis, positive pressure ventilation &gt;24 h or death), perinatal mortality, neonatal respiratory distress syndrome, mode of delivery and duration of hospitalisation for mothers and infants. <h3>Results</h3> The trial finished in December 2013, 923 women were randomised to receive early delivery and 912 expectant management. 52 (2.8%) infants had sepsis. 134 (7.3%) had severe neonatal morbidity/mortality, including 6 (0.3%) deaths and 93 (5%) ventilation &gt;24 h. 123 (6.7%) had Respiratory Distress Syndrome. 408 (22.2%) were born by caesarean section. Length of stay (median (IQR)) was 5 (4–8) days for mothers and 5 (3–9) days for infants. Analysis by intention to treat will be presented. <h3>Conclusions</h3> There is a significant rate of neonatal and maternal morbidity after maternal PPROM at 34–36⁶. If it can be demonstrated that either early planned birth or expectant management in this clinical situation is associated with less neonatal and/or maternal morbidity this will change current international practice.