Late-onset Neonatal Sepsis Research Articles

Pattern of microbial profile and their susceptibility pattern in a tertiary level neonatal intensive care unit, Dubai, UAE: 11 years surveillance study

Introduction: Neonatal sepsis is a global burden on the health and wellbeing of the neonates. It mounts too many neonatal mortality and morbidity. However, rational use of antimicrobial therapy and aggressive supportive management has modified the outcome over the past few decades. A good knowledge of locally prevalent microbes and antibiotics sensitivity pattern help in formulating antibiotics regimen. Methodology: This study is a retrospective analysis of prevalent microorganisms isolated from various culture samples collected from neonates aged 0 - 90 days, suspected to have early or late onset neonatal sepsis. All the neonates were admitted to Neonatal intensive care unit (NICU) of Latifa Women and Children Hospital (LWCH) over an 11 year period (from January 2011 till December 2021). Descriptive analyses were used with results presented as proportions. Data were analyzed using Microsoft excel 2016 and online calculators. Results: A total of 4849 microbial culture positive isolates were identified from our NICU. These isolates included samples taken from, blood, cerebrospinal fluid, endotracheal aspirates, throat/nasopharynx, urine, rectal, stool, eyes and superficial cultures. Gram-negative bacteria were isolated in 56.3% (n= 2730). Gram positive bacteria accounted for 43.7% (n=2119) of isolates. Most common isolated bacterial species were Klebsiella pneumoniae (15.7%), Coagulase Negative Staphylococcus (CONS) (14.6%), Stenotrophomonas maltophilia (11.5%) and Pseudomonas aeruginosa (11.1%). Among the multidrug resistant organism (MDRO), Extended spectrum beta lactamase (ESBL) K. pneumoniae (n=208, 4.3%) and Methicillin resistant staphylococcus aureus (MRSA) (n=145, 3%) are the predominant strain. Over the study period, there is a significant reduction in both gram positive and gram negative bacterias (n=1055 in 2011 to 226 in 2021). Discussion/conclusion: The need of the hour is implementation of strict infection control measures and rationalized use of broad-spectrum antibiotics and continuous surveillance of emergence of MDROs. Regular tracking of the microbiological prevalence pattern kept us updated regarding prevailing organisms and emergence of MDROs. Our NICU antimicrobial policy modified in accordance with the surveillance data.

A Quality Improvement Project to Reduce Antibiotic Exposure in Premature Neonates.

Overuse of antibiotics in NICUs is a problem worldwide. Unnecessary antibiotic exposure leads to resistance, changes in the microbiome, and increases the risk of bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, necrotizing enterocolitis, late-onset sepsis (LOS), and mortality in neonates. We aimed to safely reduce the antibiotic usage rate (AUR) in our level IV unit by 10% by December 2018. A multidisciplinary quality improvement project took place as part of a Vermont Oxford Network initiative in 2018. Multiple interventions took place, including identification of variations in practices and subsequent standardization through the creation of early onset and LOS guidelines, mass education, improved visibility of the guidelines, and standardized documentation. The main outcome measure for this project was the AUR for infants born <35 weeks' gestation expressed as antibiotic doses per 1000 patient days. The AUR decreased from a mean of 524 to 394, for a decrease of 24.8%. Results have been sustained for 3 years. Main contributors that led to the sustained success include decreasing the overall use of antibiotics for early onset sepsis, as well as the duration when cultures are negative. The number of LOS courses also decreased slightly. We noted no cases of inadequately treated sepsis resulting in subsequent positive cultures. Creation of guidelines with mass education and ongoing feedback/monitoring can result in a safe reduction of AUR in the NICU.

Evaluation of Changes in Leukocyte Surface Markers in the Early Diagnosis of Late-Onset Neonatal Sepsis

Abstract Objective This study aimed to evaluate the cluster of differentiation (CD)64, CD16, CD11b, CD63 human leukocyte antigen-DR (HLA-DR), and CD62L leukocyte surface marker abnormalities using flow cytometry in the early diagnosis of late-onset neonatal sepsis. Methods Forty-four neonates were included in this study. Of them, 22 neonates with clinical late-onset neonatal sepsis were included in the study group, and the remaining 22 neonates without sepsis were considered the control group. Complete sepsis screening was performed. Additionally, monocyte and neutrophil surfaces marker were examined using flow cytometry. Results The expression of the leukocyte surface markers CD16 and CD64 on monocytes and neutrophils was significantly higher in the study group than in the control group (p &lt; 0.05), while the CD63, CD62L, CD11b, and HLA-DR levels were similar to those in the control group (p &gt; 0.05). Furthermore, receiver operating characteristic curve analysis indicated that neutrophil CD64 (nCD64) is a diagnostic marker for neonatal sepsis, with an area under the curve of 0.901. The CD64 and CD16, which are the respective leukocyte surface markers on neutrophils and monocytes, are useful tests in the early diagnosis of late-onset neonatal sepsis. Conclusion In addition to acute phase proteins, cell surface antigens such as CD16 and more specifically CD64 should be used in routine investigations for the early diagnosis of late-onset neonatal sepsis. Such use in combination with acute phase reactants can improve diagnostic accuracy.

Risk factors of late onset sepsis caused by extended spectrum beta-lactamase (ESBL) - producing bacteria in preterm infants

Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection.&#x0D; Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants.&#x0D; Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors.&#x0D; Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00).&#x0D; Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.

Carboxyhemoglobin Levels in Preterm Neonatal Late-Onset Sepsis: to Predict or not to Predict.

In this study, we aimed to evaluate carboxyhemoglobin (COHb) levels in diagnosing late-onset sepsis (LOS) in preterm neonates. The records of culture-positive LOS in preterm neonates hospitalized in NICU from January 2017 to July 2022 were reviewed. COHb levels, C-reactive protein, procalcitonin, and neutrophil to lymphocyte ratio of septic preterm infants were compared to controls. In addition, serial COHb levels measured within six hours before or 24h after blood culture sampling, three to seven days prior, and three to five days after starting antimicrobial therapy were retrieved from patient records. The study included 77 blood-culture-positive preterm infants and 77 non-septic controls. During the LOS episode, the COHb values were found to be significantly increased (median: 1.8, IQR: 1.4-2.5) when compared to the control group (median: 1.2, IQR: 0.8-1.6) (p < 0.001). ROC analysis yielded an AUC of 0.714 for COHb (95% CI: 0.631-0.796, p<0.001). At an optimal cut-off of >1.5%, the test's sensitivity was 64.94%, the specificity was 72.73%, the positive predictive value was 70.42%, and the negative predictive value was 67.47%. LOS led to a dramatic rise followed by a decrease after the initiation of the antimicrobial therapy [1.8 (1.4-2.5)] vs. [1.45 (0.2-4)] p<0.001. COHb levels increased at the beginning of LOS, decreasing in response to antibiotics. When used in conjunction with other sepsis biomarkers, the variation of COHb can be important in evaluating late-onset sepsis episodes in preterm infants.

Evaluation of the utilization Neutrophil-Lymphocyte Ratio (NLR) and Immature-to-Total Neutrophil (I/T) Ratio in diagnosing Late-Onset Neonatal Sepsis (LONS) in 31-36 weeks preterm neonates in Indonesia

Background: Late-onset neonatal sepsis (LONS) is a leading cause of death and morbidity among preterm neonates. Early diagnosis is crucial for appropriate and prompt management. A rapid, simple, and readily accessible diagnostic tool is important to diagnose LONS early. This study aims to assess the diagnostic value of the neutrophil-lymphocyte ratio (NLR) and NLR combined with the immature-to-total (I/T) ratio for diagnosing LONS. Methods: This retrospective cross-sectional study collected data from Cipto Mangunkusumo Hospital Neonatology Division medical records from January 2018 to December 2019. Preterm neonates with 31-36 weeks of gestational age, 7-28 days of postnatal age, and clinical sepsis were eligible for this study. Enrolled neonates were classified into two groups, proven sepsis, and unproven sepsis. The NLR and I/T were taken from the medical records. Results: From 126 subjects, 70 were proven sepsis, and 56 were unproven. Receiver operating curve analysis for NLR was calculated, and the area under the curve of NLR corresponded to 0.953. The NLR cut-off point with the highest specificity and positive predictive value (PPV) was 1.785 (78.57% sensitivity, 92.86% specificity, 93.22% PPV, and 77.61% negative predictive value). Using a cut-off point of &gt; 0.2, the I/T ratio has 55.70% sensitivity, 83.70% specificity, 81.25% PPV, and 60.26% NPV. The NLR and I/T ratio increased the sensitivity and PPV of the I/T ratio to 90% and 84.44%, respectively. Conclusion: The NLR with cut-off point 1.785 has good diagnostic value for LONS in 31-36 weeks preterm neonates. A combination of NLR and the I/T ratio can increase the diagnostic value of the I/T ratio.

Investigation of the Effect of Neutrophil/Lymphocyte Ratio on Mortality in Late-Onset Neonatal Sepsis

Investigation of the Effect of Neutrophil/Lymphocyte Ratio on Mortality in Late-Onset Neonatal Sepsis

The Prevalence and Risk Factors of Late Onset Neonatal Sepsis in SCANU (Special Care Newborn Unit)

Background: Despite significant attempts to mitigate its effects, neonatal sepsis including late onset neonatal sepsis is regarded as a major cause of morbidity and death in newborns. Objective: In this study our main goal is to evaluate the prevalence and risk factors of late onset neonatal sepsis in SCANU (Special Care Newborn Unit). Method: This cross sectional study was carried out at tertiary medical college and hospital where 100 neonates suspected of having neonatal sepsis and admitted in the neonatal unit were included. Clinical sepsis was diagnosed based on presence of one or more of clinical features. Clinical features considered were fever (≥38.0°C), hypothermia (≤36.5°C), convulsions, lethargy, poor feeding, respiratory distress, vomiting, bulging fontanels, jaundice, and umbilical pus infections. Results: The research found that 46% of the instances occurred in the 15-22 day age range, and that 88% of the participants were female. Seventy-five percent of the babies were fed formula, 20 percent of the babies used a bottle, and 80 percent of the patients had poor hygiene status. There were 6% instances of very low birth weight and 35% occurrences of low birth weight. In addition, a cough was seen in 51.7% of cases, a cough accompanied by respiratory distress in 66.0% of cases, a fever in 76.0% of cases, a reduction in urine output in 50% of cases, convulsions in 20% of cases, a skin rash in 92.0% of cases, and jaundice in 18.0% of cases. Sixty percent were given antibiotics for 1-5 days, and 58 percent of those admitted remained in the hospital for 6-10 days. The prevalence of Klebsiella pneumoniae was highest (38%), followed by staphylococcus aureus (27%), Pseudomonas aeruginosa (15%), Citrobacter species (10%), and Klebsiella oxytoca (8%). As part of the therapy, many antibiotics were administered all at once. These included Tazid, meropenem, kacin, Gentamicin, and others. 62% of patients were advised to follow up once therapy was completed (DA). ....

Early Diagnosis of Late-Onset Neonatal Sepsis Using a Sepsis Prediction Score

Sepsis represents a common cause of morbidity in the Neonatal Intensive Care Unit (NICU). Our objective was to assess the value of clinical and laboratory parameters in predicting septicemia (positive blood culture) in NICU infants. In the first part of the present study (derivation cohort) we retrospectively reviewed the clinical files of 120 neonates with symptoms of suspected sepsis and identified clinical and laboratory parameters associated with proven sepsis on the day the blood culture was taken, as well as 24 h and 48 h earlier. These parameters were combined into a sepsis prediction score (SPS). Subsequently (validation study), we prospectively validated the performance of the SPS in a cohort of 145 neonates. The identified parameters were: temperature instability, platelet count < 150,000/mm3, feeding volume decrease > 20%, changes in blood glucose > 50%, CRP > 1 mg/dL, circulatory and respiratory deterioration. In the retrospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 82.54% sensitivity, 85.96% specificity, 5.88 PLR (Positive Likelihood Ratio), 0.20 NLR (Negative Likelihood Ratio), 86.67% PPV (Positive Predictive Value), 81.67% NPV (Negative Predictive Value) and 84.17% accuracy. In the prospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 76.60% sensitivity, 72.55% specificity, 2.79 PLR, 0.32 NLR, 83.72% PPV, 62.71% NPV and 75.17% accuracy. We concluded that this combination of clinical and laboratory parameters may assist in the prediction of septicemia in NICUs.

Longer duration of initial invasive mechanical ventilation is still a crucial risk factor for moderate-to-severe bronchopulmonary dysplasia in very preterm infants: a multicentrer prospective study

ObjectivesWe aimed to evaluate the risk factors for moderate-to-severe bronchopulmonary dysplasia (BPD) and focus on discussing its relationship with the duration of initial invasive mechanical ventilation (IMV) in very preterm neonates less than 32 weeks of gestational age (GA).MethodsWe performed a prospective cohort study involving infants born at 23–31 weeks of GA who were admitted to 47 different neonatal intensive care unit (NICU) hospitals in China from January 2018 to December 2021. Patient data were obtained from the Sina-northern Neonatal Network (SNN) Database.ResultsWe identified 6538 very preterm infants, of whom 49.5% (3236/6538) received initial IMV support, and 12.6% (823/6538) were diagnosed with moderate-to-severe BPD symptoms. The median duration of initial IMV in the moderate-to-severe BPD group was 26 (17–41) days, while in the no or mild BPD group, it was 6 (3–10) days. The incidence rate of moderate-to-severe BPD and the median duration of initial IMV were quite different across different GAs. Multivariable logistic regression analysis showed that the onset of moderate-to-severe BPD was significantly associated with the duration of initial IMV [adjusted odds ratio (AOR): 1.97; 95% confidence interval (CI): 1.10–2.67], late-onset neonatal sepsis (LONS), and patent ductus arteriosus (PDA).ConclusionIn this multicenter cohort study, the duration of initial IMV was still relatively long in very premature infants, and the longer duration of initial IMV accounts for the increased risk of moderate-to-severe BPD.

Bacteriological profiles and antibiotic susceptibility of neonatal sepsis in a university hospital of Northern India.

Knowledge of epidemiology of bacterial isolates and their anti-biograms in hospital settings is necessary for prompt empirical anti-microbial therapy of neonatal sepsis. To study risk factors, bacteriological profiles, and anti-biograms of blood culture isolates of both early and late onset neonatal sepsis. It is a prospective observational study conducted from January 2020 till July 2021 at our tertiary care center. Neonates (0-28 days) admitted to this neonatal intensive care unit clinically suspected with sepsis were subjected to blood cultures, and the isolates were identified both biochemically and by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system. Antibiotic susceptibility testing (AST) was performed as per CLSI guidelines. Chi-square test was used. Out of 280 suspected cases of neonatal sepsis, 43 (15.3%) cases showed positive blood culture. Of these, the majority (30, 69.8%) had late-onset neonatal sepsis. Major pre-disposing risk factors were pre-term birth and a low birth weight (26, 60.5%). Gram-negative bacteria and Gram-positive bacteria were isolated in 25 (58.1%) and 18 (41.9%) blood cultures, respectively. Klebsiella pneumoniae (37.5%) was the most predominant pathogen in both early-onset (23.1%) and late-onset (46.7%) sepsis. Coagulase negative Staphylococcus (34.8%) was the second most common organism and was more common in late onset (23.2%) neonatal sepsis. A high level of antibiotic resistance was noted in Klebsiella pneumoniae isolates, even to amikacin (76.5%) and carbapenems (66.7%). Increased resistance in bacterial isolates of neonatal sepsis emphasizes the need of AST of bacterial isolates for proper antibiotic administration.

Early Detection of Late Onset Neonatal Sepsis Using Machine Learning Algorithms

Early Detection of Late Onset Neonatal Sepsis Using Machine Learning Algorithms

Gram-negative Late Onset Neonatal Sepsis in a Tertiary Care Center From Central India: A Retrospective Analysis.

Neonatal sepsis has been a major cause of neonatal mortality and morbidity globally. Late onset sepsis is on the rise mostly due to better health care services and improved survival of premature neonates. Gram-negative sepsis has emerged as a major public health problem constituting significant morbidity and mortality. There is limited data on gram-negative late onset sepsis from the central part of India, therefore this study was conducted at a tertiary care center from rural part of India. To determine the clinical profile and outcome among neonates with gram-negative late onset sepsis. It is a retrospective analysis conducted among neonates with gram-negative late onset sepsis at a tertiary care center from central India. All neonates below 28 days of age suspected to have late onset sepsis were enrolled in the study. The data for the period of January 2019 to December 2021 was collected and analyzed using software SPSS version 29. The outcome variables studied were discharge (good outcome) and death (poor outcome). In the present study, overall prevalence of gram-negative late onset sepsis was 4.8%. Respiratory distress (52.2%), seizure (18.9%), jaundice (15.6%), and lethargy (15.6%) were common clinical symptoms among neonates with sepsis. The most common organism isolated was Klebsiella spp. (36.7%) followed by Acinetobacter spp. (31.1%) and E. coli (17.8%). Low gestational age (n = 20 vs n = 7, P = .002) and low birth weight (n = 33 vs n = 4, P = .02) were associated with poor outcomes in neonates with gram negative LOS. The overall mortality rate was found to be 30% among neonates with gram negative sepsis. The prevalence of gram-negative sepsis was found to be 4.8%. Factors associated with poor outcome in gram-negative sepsis were low birth weight, and prematurity. Klebsiella spp. was found to be a common cause of gram-negative LOS, therefore, the empiric antibiotic policy must provide coverage against these micro-organisms.

Isolated Protein S Deficiency Presenting in Neonatal Inferior Vena Cava as Right Atrial Thrombus: A Case Report

Critically ill neonates are at the greatest risk of developing thromboembolic disease. Multiple risk factors have been identified, one of which is isolated Protein S deficiency-a rare cause. The free form of Protein S plays a role in anticoagulation, and its deficiency can manifest as deep venous thrombosis, pulmonary emboli, and superficial thrombophlebitis. Hereby, the authors present a case report of a two-day-old female neonate, born to a gestational diabetic mother, who was initially managed for hypoglycaemia and polycythaemia. On day 4 of life, the baby was shifted to the mother’s side. Twenty-four hours later, she developed late-onset neonatal sepsis with disseminated intravascular coagulation and required management with a mechanical ventilator, Intravenous (IV) antibiotics, and inotropic support. Echocardiography (ECHO) revealed a thrombus (8.9×6.8 mm) attached to the septum of the right atrium, extending from the Inferior Vena Cava (IVC). Treatment with Low Molecular Weight Heparin (LMWH) was initiated, and a follow-up ECHO after three months showed complete resolution of the thrombus. Interval analysis revealed isolated Protein S deficiency with normal Protein C levels. The present report emphasises the importance of interval analysis in identifying causes of Neonatal Thrombotic Events (NTE). Early diagnosis and management can reduce associated morbidity and mortality.

Role of salivary c reactive protein and mean platelet volume in diagnosis of late onset neonatal pneumonia

Background: Late onset neonatal pneumonia (LONP) must be diagnosed accurately and promptly if we are to accurately assess the disease&#39;s prevalence, create better strategies for preventing and treating it, and ultimately find a cure. The combined measurement of C- reactive protein (CRP) and mean platelet volume (MPV) could be useful in determining if a patient has bacterial or viral infection and in estimating the likelihood of complications from either. The purpose of this research is to evaluate the usefulness of CRP in saliva (sCRP) and MPV in the identification of LONP. Methods: This prospective case control research was carried out on 60 full‐term neonates. The neonates were classified into 2 equal groups: Group a: included 30 neonates with LONP. Group b: included 30 healthy control neonates. All patients were subjected to thorough medical history taking and physical examination as well as measurement of salivary and serum CRP and complete blood picture for assessment of MPV. Results: MPV, sCRP, serum CRP and serum CRP / MPV are statistically significant predictors of LONP cases. SCRP at a cutoff value >3.2 is a statistically significant predictor of serum CRP> 6 in patient groups. A stastistically notable positive link between salivary and serum CRP concentrations (r = 0.476, p≤ 0.05), the research also showed significant link between serum CRP and MPV (r = 0.547, P = 0.002). There was a statistically evident link between sCRP and MPV concentrations in the pneumonic group (r =0.507, p≤ 0.05) in diagnosis of LONP. CRP/MPV ratio as predictor for diagnosis of LONP cases, was a statistically significant predictor at a cutoff value >0.6. Conclusions: Late-onset neonatal pneumonia may be diagnosed non-invasively with CRP and MPV in the saliva. The ratio of C-reactive protein to mean platelet volume (MPV) is easy to compute and has the potential to serve as a straightforward and reliable biomarker for the identification of late-onset neonatal sepsis.

Determinants of late-onset neonatal sepsis among neonates admitted to the neonatal intensive care unit of Arba-Minch general hospital, southern Ethiopia.

Neonatal sepsis can be either early (<7 Days) or late-onset ≥7days) neonatal sepsis depending on the day of the occurrence. Despite the decrement in early onset neonatal sepsis, there is still an increment in late-onset neonatal sepsis. Ethiopian demography and health survey report showed an increment in neonatal mortality in 2019/20. The objective of this study was to assess the determinants of late-onset neonatal sepsis among neonates admitted to the neonatal intensive care unit at Arba-Minch general hospital, southern Ethiopia. An institution based study was conducted from March 1, 2021, to June 30, 2021 in Arba-Minch general hospital. Cases were neonates diagnosed with late-onset neonatal sepsis with their index mother chart and controls were neonates admitted with other diagnoses at the same period. Cases and controls were selected consecutively. Data extraction tool and interview which was developed by reviewing different kinds of literature was used to collect data. Data were entered by using Epi data version 3.1software and transformed to Statistical Package for Social Sciences version 25 software for analysis. The binary logistic regression model was used to assess determinants and variables with a p-value <0.2 were transformed to multivariable logistic regression then, a p-value < 0.05 with 95% confidence interval were used to declare significant association with the outcome variable. A total of 180 subjects (60 cases and 120 controls) were included in this study. The mean age of neonates was 12.1 days with standard deviations of 4.3. Multivariable logistic regression analysis showed that; history of either sexually transmitted disease /urinary tract infection [AOR = 9.4; 95%CI(3.1-28.5)], being preterm (gestational age of <37 weeks) [AOR = 4.9; 95%CI (1.7-13.7)], use of endotracheal intubation/mechanical intubation [AOR = 8.3; 95%CI (1.8-26.4)]and either mixed types of infant feeding option or formula feeding before admission [AOR = 12.7; 95%CI(3.7-42.8)]were significantly associated with late-onset neonatal sepsis. This study revealed that antenatal, intrapartum and postpartum factors have shown an association with late-onset neonatal sepsis. It is recommended to strengthen counseling and advice to mothers with specific risk factors of late-onset neonatal sepsis.

Birth order and morbidity and mortality to hospital discharge among inborn very low-birthweight, very preterm twin infants admitted to neonatal intensive care: a retrospective cohort study

ObjectiveTo know the association of birth order with the risk of morbidity and mortality in very low-birthweight (VLBW) twin infants less than 32 weeks’ gestational age (GA).DesignRetrospective cohort study.SettingInfants admitted...

High prevalence of Panton-Valentine Leucocidin (PVL) toxin carrying MRSA and multidrug resistant gram negative bacteria in late onset neonatal sepsis indicate nosocomial spread in a Pakistani tertiary care hospital

BackgroundNeonatal sepsis has high incidence with significant mortality and morbidity rates in Pakistan. We investigated common etiological patterns of neonatal sepsis at a tertiary care setup. Methods90 pus and blood, gram negative and gram positive bacterial isolates were analyzed for virulence and antibiotic resistance gene profiling using PCR and disc diffusion methods. ResultsStaphylococcus aureus showed strong association with neonatal sepsis (43 %) followed by Citrobacter freundii (21 %), Pseudomonas aeruginosa (13 %), Escherichia coli (15 %) and Salmonella enterica (8 %). Molecular typing of E. coli isolates depicted high prevalence of the virulent F and B2 phylogroups, with 4 hypervirulent phylogroup G isolates. 76.9 % S. aureus isolates showed presence of Luk-PV, encoding for Panton-valentine leucocidin (PVL) toxin with majority also carrying MecA gene and classified as methicillin resistant S. aureus (MRSA). ecpA, papC, fimH and traT virulence genes were detected in E. coli and Salmonella isolates. 47 % Citrobacter freundii isolates carried the shiga like toxin SltII B. Antimicrobial resistance profiling depicted common resistance to cephalosporins, beta lactams and fluoroquinolones. ConclusionPresence of PVL carrying MRSA and multidrug resistant gram negative bacteria, all isolated from late onset sepsis neonates indicate a predominant nosocomial transmission pattern which may complicate management of the disease in NICU setups

The role of nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome in diagnosis of late onset neonatal sepsis.

Neonatal sepsis is a major cause of morbidity and mortality among neonates. Nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome is a core element for innate immune protection. The study aims to estimate the expression of NLRP3 inflammasome in full term newborn infants who suffer from late onset sepsis, in order to assess its diagnostic value. This case-control study was conducted in NICU. 40 newborns with late onset sepsis, and 40 control neonates were included. The analysis of NLRP3 inflammasome was done by ELISA. There was a significant elevation of NLRP3 inflammasome in the serum of neonates with late onset sepsis group than the control group, P values were < 0.001, and the best cut off value of NLRP3 to detect late onset septic was > 3 ng/ml with sensitivity of 92.5% and specificity of 97.5%. Receiver operating characteristic curve showed that the best cut off point of NLRP3 to predict mortality in cases group was > 7.29 with sensitivity of 75.0%, specificity of 91.67%, PPV of 50.0%, NPV of 97.1% and total accuracy of 0.84%. n-SOFA scoring system increased significantly among LOS group and there was positive correlation with NLRP 3 inflammasome, P < 0.012. NLRP3 inflammasome can be used for the diagnosis of late onset neonatal sepsis. The increase of its values was not affected by gender, birth weight, gestational age and postnatal age. It was the novel sepsis markers that were not fully studied in neonatal population. The prognostic values may need further studies.

Risk factors of thrombocytopenia in term infants in Prof. Dr. I.G.N.G. Hospital Denpasar Bali

Thrombocytopenia is a condition in which platelet count below 150 x 109/L. Neonatal thrombocytopenia (NT) accounts up to 35% of all patients admitted to neonatal intensive care unit (NICU). The underlying cause of NT can often be predicted by the onset time of thrombocytopenia and course of disease. The purpose of this study was to determine the risk factors of thrombocytopenia in term infants undergoing treatment at Prof. Dr. I.G.N.G. Hospital. Method: An observational analytical study using case-control design was conducted in 50 term infants from March 2021 to October 2021 in Prof. Dr. I.G.N.G. Hospital Denpasar Bali. Result: Total 25 infants with thrombocytopenia in case group and 25 infants without thrombocytopenia in control group. Most of the infants were dominated by female gender (54%), mean gestational age was 38 (± 1) weeks, birth weight 2,940 (± 445) gram, cesarean section (56%). In addition, 48% of patients were vigorous babies. Early-onset neonatal sepsis (EOS) was 76% and late-onset neonatal sepsis (LOS) was 14%, most infants had neonatal pneumonia 58% and necrotizing enterocolitis (NEC) 48%. Mothers with preeclampsia were 26%. Multivariate analysis showed EOS was risk factor for NT (OR 4.69; 95% CI 0.9 – 22.0) and NEC (OR 4.17; 95% CI 1.2 – 14.4). Conclusion: Early onset neonatal sepsis (EOS) and necrotizing enterocolitis (NEC) are risk factors for thrombocytopenia in term infants.