Onset Neonatal Sepsis Research Articles

PROPORTION OF EARLY ONSET SEPSIS IN LOCAL NICU AND IDENTIFICATION OF MATERNAL RISK FACTORS

Early onset neonatal sepsis (EOS) remains a significant cause of morbidity and mortality in neonatal intensive care units (NICUs). Identifying maternal risk factors associated with EOS is crucial for early diagnosis and prevention. Objective: To evaluate the prevalence of early onset sepsis in neonates admitted to the local neonatal intensive care unit (NICU) and identify maternal risk factors associated with neonatal sepsis. Methods: A comparative cross-sectional study was conducted at the Pediatrics Department, Combined Military Hospital Peshawar, from January 2021 to May 2022. One thousand neonates admitted to the NICU due to any indication were included. A consultant paediatrician or neonatologist diagnosed neonatal sepsis based on clinical signs and laboratory findings. Maternal factors such as age, premature rupture of membranes (PROM), maternal fever, and chorioamnionitis were analyzed for their association with early onset sepsis. Data were statistically analysed using SPSS, with p-value <0.001 considered significant. Results: Out of 1000 neonates, 690 (69%) were male and 310 (31%) were female. The mean maternal age was 33.38 ± 4.53 years. EOS was observed in 123 neonates (12.3%), while 877 (88.7%) neonates showed no signs of sepsis. PROM and chorioamnionitis were significantly associated with early-onset sepsis (p-value <0.001). Conclusion: Early onset neonatal sepsis is a common condition in neonates admitted to the NICU. Neonates born to mothers with PROM or chorioamnionitis were at a significantly higher risk of developing EOS. These findings emphasise the importance of addressing maternal risk factors in reducing the incidence of neonatal sepsis.

A study of level of procalcitonin as marker of early onset sepsis in neonates

Background: Neonatal sepsis is one of the commonest causes of morbidity and mortality. It is one of the four leading causes of morbidity and mortality in India. The purpose of this study was to evaluate the levels of procalcitonin as a rapid diagnostic test, to identify those with infection as soon as possible, and to classify them into definitive, clinical, or no sepsis. The rise in Procalcitonin levels in the neonate with sepsis is very rapid. Hence, it can be used for the diagnosis of early onset neonatal sepsis. Objectives were to estimate the concentration of Procalcitonin for diagnosis of early onset neonatal sepsis and to compare the Procalcitonin levels amongst 3 categories of neonatal sepsis (definite, clinical and no sepsis). Methods: This is a hospital based analytical prospective study. Results: 104 babies with early onset sepsis were included in the study from the NICU in tertiary health care center. Procalcitonin is positive in 69 (66.35%) and negative in 35 (33.65%). Out of the total 69 neonates with Procalcitonin positive, 42 (60.8%) neonates are preterm and 27 (39.1%) are term neonates. Out of the total 35 neonates with Procalcitonin negative, 24 (68.5%) neonates are preterm and 11 (31.4%) are term neonates. There was no sepsis observed in 57 (54.8%) of cases, clinical sepsis was observed in 34 (32.6%) of cases and definite sepsis was observed in 13 (12.5%). The mean value of level of Procalcitonin in different categories of sepsis as determined from the data is 3.27 ng/ml in cases of No sepsis, 11.79 ng/ml in cases of clinical sepsis and 17.2 ng/ml in cases of definitive sepsis. Conclusions: Procalcitonin has good sensitivity and hence can detect most cases of neonatal sepsis and good negative predictive value. Procalcitonin contributes more significantly to the diagnosis of newborn septicemia when paired with additional testing and helps in identifying the categories of sepsis in neonates.

Risk factors for death caused by early onset sepsis in neonates: a retrospective cohort study

ObjectiveTo evaluate the association between traditional laboratory findings and death, and to find risk factors for death in infants with early onset sepsis (EOS).Study designThis was a single-center, case–control, retrospective trial conducted between January 2020 and August 2021. Infants with EOS were enrolled and divided into two groups based on outcome before hospital discharge: non-survivors (Mortality group) and survivors (Survival group).ResultsOut of 556 eligible neonates, there were 38 (6.8%) deaths. After univariate analysis and ROC curve analysis, there were a total of 12 values with significant differences (p < 0.05) between two groups, which included birth weight (BW), weight on admission, gestational age, age on admission, mode of delivery, septic shock, heart failure, respiratory failure, pulmonary hypertension, hypothermia, serum lactic acid, and aspartate aminotransferase (AST). Moreover, after multivariate analysis performed for those 12 values, the binary logistic regression analysis showed that taking death as a reference, the BW (OR = 1.00, 95% CI[1.001, 1.002], p < 0.001), PPHN (OR = 2.60, 95% CI[1.04, 6.52], p > 0.001), septic shock (OR = 6.15, 95% CI [2.52, 15.00], p < 0.001), heart failure (OR = 6.22, 95% CI[0.90, 43.05], p > 0.001), serum lactic acid (OR = 0.82, 95%CI[0.75, 0.90], p < 0.001), and AST (OR = 1.00, 95% CI[0.99, 1.00], p > 0.001) could be regarded as risk factors for death with 94.0% correct predictions.ConclusionsThe factors affecting the prognosis of EOS in neonates were BW, PPHN, septic shock, heart failure, serum lactic acid, and AST. Timely correction of these modifiable risk factors for death may decrease the mortality of EOS in neonates.

Early Onset Sepsis in Neonates

Background Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. The most common risk factors associated with early onset sepsis (EOS) are preterm delivery, low birth weight, premature rupture of membranes, maternal urinary tract infection, Clinical manifestations of neonatal sepsis are nonspecific. These include temperature instability, respiratory distress, apnea, poor feeding, lethargy, irritability, convulsions, hypotonia, poor perfusion and abdominal distension Aim and objectives To describe epidemiology, demographic and incidence of early onset sepsis in neonate with risk factors at NICUS of Ain Shams University Hospitals. Subjects and methods This study is prospective cohort study, was carried out on 80 neonates with one or more maternal risk factors associated with EOS. Neonates will be completely evaluated and subsequently discriminated over the period of 1st 72hours of life in Neonates with risk factors for early-onset sepsis. diagnosis of EOS will be established based on the presence of any clinical evidence suggestive of sepsis, quantitatie C-reactive protein (CRP) levels ≥6 mg/dL, Rodwell’s hematological scores ≥3 and/or Tollner’s scores ≥ 10 with or without positive blood culture results, within the 1st 72 hours postnatal age. Result Among the studied maternal risk factors of neonatal sepsis in our study, 73.8% had PROM being the most common maternal risk factor for early neonatal sepsis followed by ceserian mode (C.S) of delivery 66.3%, and 26.2% had Chorioamintis. The gestational age was distributed as 36.76±3.01 with minimum 30 and maximum 42 weeks, of Ballard score 37.05±2.88 and weight was 2.87±0.82. 58.8% were females and 41.3% were males. Also, 42.5% of the studied group was preterm. 42.5% of studied group was diagnosed with sepsis. Conclusion Early diagnosis is important for early intervention and treatment. This diagnosis in neonates is usually based on clinical and laboratory findings.

Bacteria causing early onset sepsis in neonates, neonatal intensive care unit at tertiary care hospital SKBZ/CMH Muzaffarabad, Azad Kashmir

Bacteria causing early onset sepsis in neonates, neonatal intensive care unit at tertiary care hospital SKBZ/CMH Muzaffarabad, Azad Kashmir

Risk factors for neonatal sepsis among neonates in the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital and Adare General Hospital in Hawassa City, Ethiopia.

Neonatal sepsis (NS) is a serious blood bacterial infection in children of 28 days or younger, manifested by systemic signs and symptoms of infection. Neonatal sepsis has become one of the leading causes of admission and death in developing countries like Ethiopia. Understanding different risk factors for neonatal sepsis is essential for early diagnosis and treatment. So, this study aimed to assess the risk factors for neonatal sepsis among neonates at Hawassa University Comprehensive Specialized Hospital and Adare General Hospital in Hawassa City, Ethiopia. A case-control study design was employed on 264 neonates (66 cases and 198 controls) in Hawassa University Comprehensive Specialized Hospital and Adare General Hospital from April to June 2018. Data were collected by interviewing the mothers and reviewing neonates' medical records. The data were edited, cleaned, coded, and entered into Epi info version 7 and were transported and analyzed using SPSS version 20. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the significance of the associations. A total of 264 neonates (66 cases and 198 controls) with 100% response rate. The mean (±SD) age of mothers was 26 ± 4.042 years. The majority (84.8%) of the cases were found in children under 7 days, with a mean age of 3.32 days ± 3.376 SD. Factors such as prolonged rupture of the membrane [AOR = 4.627; 95% CI (1.997-10.72)], history of the urinary tract or sexually transmitted infections [AOR = 2.5; 95% CI (1.151-5.726)], intrapartum fever [AOR = 3.481; 95% CI (1.18-10.21)], foul smelling liquor [AOR = 3.64; 95% CI (1.034-12.86)], and low APGAR score in the fifth minute [AOR = 3.38; 95% CI (1.107-10.31)] were the independent predictors of neonatal sepsis. Prolonged rupture of the membrane, intrapartum fever, urinary tract infection, foul-smelling liquor, and low APGAR score were independent risk factors of neonatal sepsis, and this study also observed that the onset of neonatal sepsis was higher in the first week of a neonate's life. Routine sepsis evaluation must focus on neonates born with the aforementioned characteristics and make interventions for babies born with these risk factors.

Correlation Between Prematurity and The Onset of Neonatal Sepsis: A Cross-Sectional Study in NICU of a Tertiary Hospital in East Java, Indonesia

INTRODUCTION: The incidence of neonatal sepsis in developing countries is still high, reaching 170 out of 1000 births. An increased premature birth rate has become the leading cause of death in children under five years old. Studies examining the correlation between prematurity and neonatal sepsis onset have not been widely reported. Therefore, we assessed the correlation between gestational age and the onset of sepsis in neonatal patients.METHODS: Hospital-based cross-sectional study was performed on all neonates diagnosed with neonatal sepsis in the NICU of a tertiary referral hospital in East Java between 1 January 2019 – 31 December 2019. Logistic regression was used to analyze the obtained data. P-value &lt;0.05 was considered statistically significant. RESULTS: Of the 241 patients identified with neonatal sepsis at Dr. Soetomo General Hospital in 2019, we found that 161 patients met the inclusion criteria, with most patients being early-onset sepsis patients (67.7%), low birth weight (75.8%), premature (65.2%), singleton deliveries (92.5%), and cesarean section births (65.2%). Statistical analysis showed a non-significant correlation between prematurity and the onset of neonatal sepsis (p&gt;0.05).CONCLUSION: Although preterm birth is often reported as one of the most important risk factors of neonatal sepsis, prematurity does not appear to be an independent risk factor of neonatal sepsis onset

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.

The Association between Birth Route and Early/Late onset Neonatal Sepsis in Term Infants: A Case-control Study in the NICU of a Tertiary Hospital in East Java, Indonesia

The Association between Birth Route and Early/Late onset Neonatal Sepsis in Term Infants: A Case-control Study in the NICU of a Tertiary Hospital in East Java, Indonesia

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 &lt;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.

Antibiotic resistance pattern of extended-spectrum-beta lactamases-producing Escherichia coli isolated from pregnant women and their new born

The incidence of healthy pregnant women carrying CTX-M-type extended-spectrum beta-lactamase (ESBL)-producing E. coli and their transmission to neonates is increasing worldwide. ESBL-E coli and especially the carriage of CTX-M-type causes early or late onset of neonatal sepsis, resulting in increased morbidity and mortality rates. Although maternal carriage and maternal-neonatal transmissions of ESBL-E have been reported in several countries, the prevalence of CTX-M-type ESBL-producing E. coli in pregnant women and its transmission to newborns at birth in Cameroon has not been reported yet. We describe here the carriage of CTX-M-type ESBL-producing E. coli pregnant women in neonatal ward of the Yaoundé gyneco-obstetric and pediatric hospital and their transmission to newborns. Among the 102 pregnant women and their newborns present in the ward, 88 (86.3%) and 75 (73.5%) E. coli strains were detected in rectal colonization, respectively. Antibiotic susceptibility testing of E. coli isolated from the mothers indicated a higher resistance rate to antibiotics of the β-lactams and sulfamide families, while the resistances to other antibiotic families (aminosides, quinolones and fluoroquinolones) were low. Comparatively, only cefotaxime (100%) showed a higher resistance rate to E. coli isolated from newborns. This may suggest a different source of contamination between mothers and newborns. Moreover, the rate of carriage of CTX-M-type ESBL-producing E. coli in pregnant mother and their newborns were 30.7 % and 14.7 %, respectively. This suggests that newborns had other colonization sources than the mothers. Indeed, multiple regression analysis indicated that newborns were exposed to CTX-M-type ESBL-producing E. coli from mothers and that from the hospital environment (eg. caregivers). Overall, the current investigation may provide insight on establishing an efficient therapeutic strategy against materno-neonatal and nosocomial transmission of CTX-M-type ESBL-producing E. coli.

Bacterial uropathogens causing late onset sepsis in neonates at a tertiary care hospital.

Objective: To find out different bacterial isolates of urinary tract infection (UTI) in neonates with late onset sepsis (LOS) at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Nishtar Hospital Multan. Period: August 2020 to February 2021. Material &amp; Methods: A total of 176 neonates with LOS and culture positive UTI were enrolled. The urine samples were sent to the institutional laboratory for isolation and identification of the causative agents. Baseline information like age, gender, socioeconomic status, family system and maternal literacy were noted. Once registered, the urine samples were sent to the laboratory of the hospital for isolation and identification of the causative agents. Urine samples were collected within 48 hours of admission. Results: Of the 176 neonates, 110 (62.5%) were male while 66 (37.5%) were female. Overall, mean age was 8.64±5.22 days. There were 90 (51.1%) neonates who belonged to rural areas and 86 (48.9%) to urban areas. Poor socioeconomic status was noted in 116 (65.9%) neonates. In terms of maternal literacy, 118 (67.0%) mothers were illiterate. Overall, mean gestational age was 38.59 ± 2.17 weeks. Escherichia coli (E. coli) was the predominant causative organism noted among 146 (83.0%) neonates whereas Klebsiella was seen in 23 (13.1%) while other bacterial isolates were Proteus 2 (1.1%), Pseudomonas aeruginosa 1 (0.6%), Enterobacter aerogenes 1 (0.6%), Enterococcus fecalis 1 (0.6%), Staphylococcus aureus 1 (0.6%) and Group B Streptococcus 1 (0.6%). Conclusion: High frequency of Escherichia coli was observed followed by Klebsiella among neonates having urinary tract infection presenting with late onset of sepsis in our study.

Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities.

Neonatal sepsis is defined as a systemic infection within the first 28 days of life, with early-onset sepsis (EOS) occurring within the first 72h, although the definition of EOS varies in literature. Whilst the global incidence has dramatically reduced over the last decade, neonatal sepsis remains an important cause of neonatal mortality, highest in low- and middle-income countries (LMICs). Symptoms at the onset of neonatal sepsis can be subtle, and therefore EOS is often difficult to diagnose from clinical presentation and laboratory testing and blood cultures are not always conclusive or accessible, especially in resource limited countries. Although the World Health Organisation (WHO) currently advocates a ß-lactam, and gentamicin for first line treatment, availability and cost influence the empirical antibiotic therapy administered. Antibiotic treatment of neonatal sepsis in LMICs is highly variable, partially caused by factors such as cost of antibiotics (and who pays for them) and access to certain antibiotics. Antimicrobial resistance (AMR) has increased considerably over the past decade and this review discusses current microbiology data available in the context of the diagnosis, and treatment for EOS. Importantly, this review highlights a large variability in data availability, methodology, availability of diagnostics, and aetiology of sepsis pathogens.

Etiology and risk factors of early and late onset neonatal sepsis

Neonatal sepsis is a systemic disease caused by bacterial organisms, viral infections, or fungus that causes hemodynamic abnormalities and other clinical symptoms resulting in severe complications and may progress into mortality. Parturition can be used to diagnose organisms caused by the premature onset of sepsis in some cases, but only after an average of three days of life. Clinical manifestations of infection may also diagnose the organisms caused by the early onset of sepsis. Late sepsis can refer to any incident of sepsis from delivery to discharge in high-risk newborns, and the majority of them have been hospitalized for a lengthy period. Late-onset Guillain-Barré syndrome infections generally refer to the infections that occur between one week and up to three months post-labor. The precise load fraction for newborn sepsis varies by context, with differing load estimations between nations with varying lead levels. With the diversity of treatments utilized, explaining the degree of obstetric palsy is crucial and complicated. When comparing birthing sepsis rates, it is critical to understand if a tiny figure represents a total birth rate or another rate, such as a hospital admission number. As stated, it is critical to evaluate if population estimates based on the numbers of neonatal sepsis episodes have been recorded. This article aims to review the literature regarding neonatal sepsis from different aspects including, the etiology, risk factors, and different types and onset of neonatal sepsis.

Relation between urine soluble trigerring receptor expressed on myeloid cells (sTERM-1 ) and blood culture for diagnosis of late onset sepsis in neonates

Background: The sepsis gold standard is to identify the blood-growing agent. However, the production of a pathogen is not feasible for various reasons, even in the finest facilities. The purpose of this research was to identify the relationship between myeloid cell myeloid cell (STREM-1)-soluble trigger receptor and blood culture to diagnose late onset septicism. Methods: 100 cases from newborn intensive care units (NICU) divided into the following categories were included in this comparative case/check research. Group 1: 60 patients with positive blood culture sepsis included, Group 2: 40 patients with negative blood culture sepsis and Group 3: 100 patients with healthy neonate. All of the newborns included have been submitted to comprehensive history, clinical and laboratory tests of CBC, CRP and urine sTREM-1. Outcome: 60 (60%) instances of positive blood culture were 83,28 ± 6,17 pg/ml of the mean uTREM1, compared to 51,19 ± 19,47 pg/ml of the negative crop group and 78,22 ± 0,25 pg/ml of the checks, p 72 pg/ml, the specificity was 95 percent, 96.7 percent and 97.4 percent. Conclusion: Our findings support the use of uTREM-1 in newborn sepsis as a potentially simple and reliable diagnostic while awaiting results and results in culture.

Risk factors and etiology of neonatal sepsis after hospital delivery: A case-control study in a tertiary care hospital of Rajshahi, Bangladesh.

Sepsis is one of the major causes of neonatal death worldwide as well as in Bangladesh. The objective of the present study was to identify the risk factors and causative organisms of neonatal sepsis after delivery in a tertiary care hospital, Bangladesh. This was a case-control study conducted in the neonatal ward of Rajshahi Medical College Hospital (RMCH), a 1000-bed tertiary hospital situated in Rajshahi, Bangladesh. Neonates diagnosed as neonatal sepsis by clinical and laboratory parameters were included as cases in this study. Admitted neonates unsuspected or undiagnosed for sepsis were considered as controls. Maternal and neonatal information and their laboratory reports were collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal sepsis. A total of 91 cases and 193 controls were included in the study. Maternal history of urinary tract infection (UTI) during the third trimester of pregnancy (aOR 2.75, 95% CI: 1.04-7.23, p <0.05), premature birth (aOR 2.77, 95% CI: 1.08-7.13, p <0.05) and APGAR score <7 at five minutes (aOR 2.58, 95% CI: 1.04-6.39, p <0.05) were associated with onset of neonatal sepsis in multiple logistic regression model. All these factors were also associated with developing early-onset neonatal sepsis, while maternal UTI and male sex of neonates were associated with developing late-onset neonatal sepsis. Escherichia coli (40.7%), Staphylococcus aureus (27.5%), and Klebsiella pneumoniae (18.7%) were the commonly isolated organisms causing neonatal sepsis. All these organisms were highly resistant to common antibiotics like amoxicillin, cephalosporins, aminoglycosides and quinolones. Carbapenemase group of drugs along with amikacin, nitrofurantoin and linezolid were the most sensitive drugs. Strengthening the existing facility for antenatal screening for early diagnosis and treatment of maternal infection during pregnancy as well as identifying high-risk pregnancy for adequate perinatal management is necessary to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics according to local epidemiology and culture and sensitivity reports may minimize the increasing hazards of antibiotic resistance.

Can a Presepsin (Scd14-St) Obtained from Tracheal Aspirate Be a Biomarker for Early- Onset Neonatal Sepsis

Abstract In absence of clear clinical signs and clear definition, neonatal sepsis is still one of the major cause of morbidity and mortality. Most researchs in past time was directional on finding new biomarkers with greater sensitivity and specificity in detection of neonatal sepsis. The aim of our study was to investigate if presepsin obtained from tracheal asprate in intubated newborns, can be a novel biomarker of systemic bacterial infection. Our ‘’case control’’ study included 60 newborns, 11 with suspected neonatal sepsis. Tracheal aspirate for examination was taken in the usual toilets, in aseptic conditions, by lavage with 2 ml of 0.9% NaCl in Mucus suction set. In the same day were mesured presepsin (blood), CRP, PCT, leukocytes and neutrophyls, as well as blood culture. Our research showed higher levels for PCT and presepsin (blood) in septic newborns, as well as in newborns with clinical signs of SIRS. Presepsin obtained from a tracheal aspirate had high score for septic newborns. As the coefficients of simple linear correlation showed, there was quantitative agreement between presepsin (blood) with presepsin (tracheal aspirate)- increase in the value of one leads to an increase in other. In conjunction with an already validated markers of infection, presepsin obtained from tracheal aspirate cam be turned on in diagnostic procedures.

Decrease in Group B Streptococcal Infections in Neonates: Analysis of Health Insurance Data 2005 to 2017

In the German guidelines for prophylaxis of group B streptococcal (GBS) early onset sepsis in neonates (EOS), GBS screening of all pregnant women has been recommended, but is not yet included in the Maternity Directives. Aim of the study was to identify temporal trends in incidence of EOS and their association to GBS Screening. The analysis based on health insurance data of the statutory health insurance provider Barmer from 2005 to 2017 of 313,385 mother-child pairs. Annual frequency of GBS infections in newborns was determined by ICD-10 P36.0. The frequency of maternal GBS colonization was indicated by ICD-10 B95.1, which was used as surrogate for GBS screening. Temporal trends of the risk of EOS in neonates were assessed in logistic regression models. Pearson's correlation coefficient of EOS incidence and the surrogate marker for maternal GBS colonization was calculated. The risk of EOS in neonates caused by GBS has decreased annually by 9.3%, resulting in an overall decrease in the observation period of 72.0%. There was no statistical significant change in the risk for LOS (Late Onset Sepsis). The decrease of EOS could not be explained by temporal changes in Caesarian section, risk factors or preterm delivery. The 3.5 fold increase in the proportion of mothers with documented positive GBS colonization in the same period correlated inversely with the incidence of EOS (r=- 0.75; p=0.002). The decrease of EOS in neonates caused by GBS in Germany and the unchanged risk of LOS in neonates may be explained by the increasing application of the GBS Screening in pregnant women.

Clinical Profile of Neonatal Early Onset Sepsis: A Study on the Current Scenario

Background: Neonatal early onset sepsis remains to be a challenge in India, owing to its variable presentation, diagnostic difficulty and high fatality. An attempt needs to be made to study its clinical profile for easy identification of such babies, with new antibiotic guidelines formulated based on current microorganisms isolated. The aim of the study is to study the clinical profile of early onset sepsis in neonates in terms of the risk factors, clinical factors and etiology, and ascertain factors associated with definite sepsis. Subjects and Methods: This hospital based cross-sectional study enrolled neonates with suspected early onset sepsis. Those with congenital anomalies, surgical conditions, gestation &lt;28 weeks and birth weight &lt;1kg excluded. Subjects were subjected to sepsis screen and blood culture, and their perinatal history recorded. Blood culture positive babies were considered to have definite sepsis. Data was analysed using Chi square with SPSS 18. Results: Among 300 babies enrolled, 70 babies had definite sepsis. The most common organism isolated was Klebsiella (27.1%) and Staphylococcus hemolyticus (21.4%), most showing sensitivity to Ampicillin and Gentamicin. Respiratory distress was the commonest presentation (71.3%). A significant association with definite sepsis was seen with prematurity (p =0.0026) and low birth weight (p =0.0052), perinatal risk factors namely premature rupture of membranes (p =0.004), foul smelling liquor (p=0.016) and birth asphyxia (p-value=0.02). 28.3% had positive sepsis screen, which was significant (p = 0.001). Conclusion: Early onset sepsis needs prompt identification and treatment initiation, possible with aid of sepsis screen and high index of suspicion with certain perinatal risk factors and gestational age and birth weight.

Improving Antibiotic Stewardship Among Asymptomatic Newborns Born at or Greater than 36 Weeks Using the Neonatal Early Onset Risk Calculator

Background: The potential deleterious effects of antibiotic use in newborns have made antibiotic stewardship for asymptomatic newborns a priority. In January 2016, we instituted a newborn sepsis protocol based largely on the 2012 AAP guidelines. By December 2016, we determined that our antibiotic use had not decreased, and resolved to conduct a PDSA cycle to decrease antibiotic usage. Beginning in June of 2017, we adopted a clinical algorithm which integrated the use of the Neonatal Early Onset Sepsis (EOS) Risk Calculator at birth. We were able to decrease the use …