Probable Sepsis Research Articles

Diagnostic Value of Assessment of Serum Cortisol, Hepcidin and Thyroid Hormones Levels in Neonates with Late-Onset Sepsis.

Neonatal sepsis is a clinical syndrome characterized by symptoms and signs of infection in the first twenty-eight days of life. Serum thyroid, cortisol and hepcidin are affected by neonatal sepsis. ; Aim of the Work: The aim of this study was to assess the diagnostic value of serum thyroid hormones including free triiodothyronine (free TT3) and free tetraiodothyronine (free TT4), serum cortisol and hepcidin levels through comparison of their concentrations between normal neonates and neonates with high probable late-onset sepsis. ; Patients and Methods: This case-control study was carried out on 40 neonates with suspected high probable late-onset neonatal sepsis based on clinical and laboratory finding who were admitted to NICU of Pediatric Department, Tanta University, Egypt in the period from April 2017 to May 2019 (group I) and 40 healthy neonates matched in age and sex as a control group (group II). For patients and controls, blood culture, highly sensitive C-reactive protein (H-s CRP), serum hepcidin, serum cortisol and thyroid hormones levels including free TT3 and free TT4 were assessed. ; Results: There were no significant differences between studied groups regarding weight, gestational age, sex and mode of delivery. H-s CRP, serum cortisol and hepcidin were significantly higher in group I than group II while serum-free TT3 and free TT4 were significantly lower in group I compared with controls (group II). There was significantly lower H-s CRP, serum hepcidin and cortisol and significantly higher serum-free TT3 and free TT4 in group I after antibiotic therapy compared to the same group before treatment while there were no significant differences between group I after antibiotic therapy and control group (group II) regarding the same parameters. There was a significant positive correlation between H-s CRP and serum hepcidin and cortisol in group I while there was a significant negative correlation between H-s CRP and free TT3 and free TT4. ROC curve of specificity and sensitivity of H-s CRP, serum hepcidin, cortisol, free TT3 and free TT4 in the prediction of neonatal sepsis shows that serum hepcidin had the highest sensitivity and specificity with 95% and 90% respectively followed by serum cortisol, H-s CRP, free TT3 and lastly free TT4. ; Conclusion and Recommendations: Neonates with high probable sepsis had significantly higher serum cortisol and hepcidin and significantly lower free TT3 and free TT4 compared with healthy neonates. These findings may draw our attention about the use of these markers in the diagnosis of neonatal sepsis which can help in early treatment and subsequently better prognosis.

Neutrophil Volume, conductivity and scatter (VCS) as a screening tool in neonatal sepsis

The initial evaluation of a suspected sepsis in a neonate is always challenging. There are many methods to screen a neonate with suspected sepsis. One of newer method is to assess the changes in neutrophil volume conductivity and scatter. The objective of this study was to establish changes in Neutrophil volume conductivity scatter (VCS) in neonatal sepsis and to determine appropriate cut off levels using receiver operating characteristic (ROC) curves. Neonates with suspected sepsis were evaluated with blood counts, culture and neutrophil VCS parameters. Based on these parameters neonates were classified into sepsis group (Blood culture positive), Probable sepsis group (clinical course consistent with sepsis and positive sepsis screen and negative blood culture), No sepsis group (Clinical course not suggestive of sepsis with negative sepsis screen and blood culture). A total of 304 neonates were included in the study of which 144 were in sepsis group and 160 in no sepsis group respectively. Among the neutrophil VCS parameters there was significant difference between the groups with respect to mean neutrophil volume (MNV) and volume distribution width (VDW) (180 vs 163 vs 150) (p < 0.01). MNV and VDW had good sensitivity (95%, 82%) and specificity (86%, 74%) for diagnosis of sepsis. In conclusion, Neutrophil VCS parameters, especially MNV, can be incorporated with other sepsis screen parameters in diagnosis of neonatal sepsis.

Association of Early-Onset Sepsis and Vitamin D Deficiency in Term Neonates

To determine if vitamin D status is affected in term neonates with early onset sepsis and its association with outcome. Study was done at a level 3 neonatal unit on 140 neonates. Term neonates with early onset sepsis (study group, 70 patients) and without sepsis (control group, 70 patients) were enrolled. Mean neonatal vitamin D level in the study group was 16.00 (10.49) ng/mL and in the control group, was 29.07(8.36) ng/mL (P =0.061). In the study group 80% (n=56) babies had low vitamin D levels (<32 ng/mL) among whom 51.7% (n=29) had severe vitamin D deficiency (<11ng/mL). In the control group, 58.5% (n=41) had low vitamin D levels of whom, 9.8% (n=4) had severe vitamin D deficiency (P<0.001 and P<0.001, respectively). Mortality and highly probable sepsis were more common with vitamin D levels <11ng/mL in the study group (P= 0.005 and P=0.006, respectively). Vitamin D is deficient in neonates with early onset sepsis and is associated with increased sepsis severity and mortality.

Study of hematological parameters in the early diagnosis of neonatal sepsis in tertiary care center in Jharkhand

Background: Bacterial sepsis is a major cause of morbidity and mortality in newborns. Probable sepsis is a clinical and laboratory finding consistent with bacterial infection without a positive culture. Objectives: The objectives of the study were to study and determine the predictive value of hematological parameters in the early diagnosis of neonatal sepsis at a tertiary care center in Jharkhand. Materials and Methods: This was a prospective study conducted from July 2016 to June 2017 in a tertiary care teaching hospital in Jharkhand. A total of 110 neonates admitted in neonatal intensive care unit of the hospital, with either clinical suspicion of sepsis or having predisposing perinatal factors for sepsis, were included in the study. In this study, hematological scoring system (HSS) along with clinical profile of patient and sepsis screening tests was studied. Sensitivity, specificity, and positive predictive value (PPV) of each parameter were studied and analyzed. Results: Out of 46 cases with culture-proven sepsis, 40 (86.95%) infants had score ?5 and 6 (13.04%) had scores 3–4. HSS had a sensitivity of 86.95% and a specificity of 78.12%. HSS had PPV of 74.07%. Male babies were observed to be affected more than female babies. Conclusion: As no single individual hematological parameter is superior to other in predicting neonatal sepsis, a combination of these parameters in the form of HSS and C-reactive protein has been recommended. We conclude that HSS is a useful test to distinguish the infected from non-infected neonates.

Prevalence, risk factors, and outcome of hospitalization of neonatal hyperglycemia at a Nigerian health facility.

Neonatal hyperglycemia (NNH) like hypoglycemia is a dangerous metabolic disorder often associated with adverse consequences, if undetected and untreated. This study was set out to determine the prevalence, risk factors, and outcomes of babies with the point of admission hyperglycaemia at the Wesley Guild Hospital (WGH), Ilesa. The study was descriptive and cross-sectional, involving 300 consecutively recruited neonates admitted into the special care baby unit (SCBU) of the hospital. All subjects had blood glucose done at the point of admission using Accu-Chek Active® glucometer (Roche Diagnostics GmbH, Germany). Hyperglycemia was defined as blood glucose ≥7.0 mmol/L. Factors associated with NNH were determined using univariate and multivariate analyses. Of the 300 subjects (Male: Female 1.5:1), there were 74 (24.7%) preterms, 35 (11.7%) small-for-gestational age and 85 (28.3%) low-birth-weight babies. Eighteen (6.0%) babies had hyperglycemia. Parental low socioeconomic class, maternal lack of antenatal care (ANC), vaginal delivery, grand multiparity, outborn status, respiratory distress, probable sepsis, and neonatal anemia at presentation were associated with NNH (P < 0.05). Respiratory distress (OR = 3.800, 95% CI = 1.122-12.873, P = 0.032), and probable sepsis (OR = 4.090, 95% CI = 1.206-13.872, P = 0.024) were independent predictors of hyperglycemia. Hyperglycemia was significantly associated with mortality. (38.9% vs. 11.0%; P = 0.001). Neonatal hyperglycemia was detected in 6.0% of neonatal admission at the WGH, Ilesa and it was associated with increased mortality. Hyperglycemia should be suspected and promptly managed at the point of admission of ill newborns particularly those with respiratory distress and signs of sepsis.

Prevalence of glucose level abnormalities in neonatal sepsis and its association with mortality

Objective To determine the prevalence of plasma glucose abnormalities among infants with neonatal sepsis and their association with mortality and morbidity. Background Plasma glucose abnormalities were previously noted in neonatal sepsis, but data in full-term neonates is limited and the association with mortality and morbidity is not established. Patients and methods This was a prospective observational study including 114 full-term neonates with culture-proven and probable sepsis. Plasma glucose level was measured within 2 h of neonatal intensive care unit admission and the patients were monitored till discharge or mortality. The patients were divided into three groups according to their plasma glucose level into hyperglycemic, hypoglycemic, and normoglycemic subgroups. Results Of the patients, 8.7% were hyperglycaemic; 8.7% were hypoglycemic, and 82.6% were normoglycemic. Mortality in the hypoglycemic, hyperglycemic, and normoglycemic subgroups were 20, 20, and 17%, respectively (P = 0.8). There was no significant difference in the length of hospital stay according to the glycemic status (P = 0.3). In addition, the glycemic status was not associated with the need for mechanical ventilation (P = 0.99). Conclusion Plasma glucose abnormalities are not uncommon among full-term neonates with sepsis. However, these abnormalities are not associated with morbidity or mortality. Larger studies are needed to confirm these findings.

Role of Micro ESR in the Evaluation of Neonatal Sepsis

INTRODUCTION: In a developing country like Nepal, where proper medical care and obstetrical facilities are still scarce in the rural areas, neonatal sepsis is a major cause of neonatal morbidity and mortality. With limited resources, early diagnosis and treatment if crucial, may not be achieved. Objective of this study is to evaluate the role of micro ESR in the diagnosis of neonatal sepsis.&#x0D; MATERIAL AND METHODS: A prospective analytical study was done where all neonates with suspected sepsis admitted in NICU were included in the study. Micro-ESR was measured with relevant septic screening investigations. The micro-ESR was compared with age specific cut off value and the results were compared with various clinical presentations, laboratory findings and outcome variables.&#x0D; RESULTS: Out of 250 neonates, micro-ESR was elevated in 12% (29 neonates) of cases. Total proven sepsis is 6%, probable sepsis 60.8% and no sepsis in 33.2%. Correlation of elevated micro ESR was statistically significant with presence of clinical symptoms, clinical and systemic signs. It had significant clinical association with blood culture and CSF findings. The sensitivity, specificity and positive and negative predictive value of micro ESR compared to blood culture was 93.3%, 93.6%, 48.3% and 99.5%.&#x0D; CONCLUSION:- Micro ESR is a simple, relatively cheap and sensitive study in prediction of neonatal sepsis. It can be useful test in settings with limited resources.

Diagnostic Value of Immature-to-Total Neutrophil Ratio in Neonatal Sepsis

Background: Neonatal sepsis is the third most common reason of neonatal mortality in Pakistan. Blood culture, the gold standard test for diagnosis of neonatal sepsis, is time consuming. Therefore, rapid diagnostic tests with good specificity and sensitivity is needed for accurate and early diagnosis of this condition. The objective of this study was to determine the diagnostic value of abnormal (≥ 0.2) immature-to-total-neutrophil ratio in neonatal sepsis.Material and Methods: This cross-sectional study was carried out on 288 neonates, aged 0-28 days, admitted with suspected sepsis. Detailed history of the neonates was recorded including gender, age, birth weight, maternal age, gestational age and clinical features. Blood culture and Peripheral blood films were done in each case. Differential leucocyte counts, total Polymorphoneutrophil count (PMN), immature neutrophil count, mature neutrophil count and calculation of I/T ratio was carried out in the Pathology Department of PIMS, Islamabad. The study outcome was divided into three groups on the basis of positive or negative blood culture and I/T ratio as normal, probable sepsis and proven sepsis group. Data was analyzed by SPSS version 21.0. Diagnostic value of I/T ratio was determined in NS by calculating values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) by considering the blood culture as the gold standard test of NS.Results: The mean age and weight of the neonates at the time of admission was 1.1 (± 0.6) days and 2.51 (± 0.40) kg, respectively. About 60% of the neonates were males and 118(41%) neonates had I/T ratio of ≥ 0.2. On the basis of positive or negative blood culture and I/T ratio, 82 (28.5%) neonates were diagnosed as proven sepsis, 43 (14.9%) neonates had probable sepsis and remaining 163 (56.6%) neonates were declared as normal. Out of 82 neonates with positive blood cultures, 75 (91.5%) had I/T ratio ≥ 0.2, while 7 (8.5%) had I/T ratio ≤ 0.2. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of abnormal I/T ratio to diagnose neonatal sepsis was 91%, 79%, 64%, 96% and 83%, respectively.Conclusions: Due to substantially high diagnostic accuracy of I/T ratio ≥ 0.2, we recommend it as a useful, rapid and cost-effective tool in accurate diagnosis of neonatal sepsis.

Predictors of Mortality in Children Admitted to the Pediatric Intensive Care Unit with Acute Gastroenteritis with Severe Dehydration.

The objective of the present study was to identify risk factors for mortality at admission in children admitted to the Pediatric Intensive Care Unit (PICU) with acute gastroenteritis (AGE) with severe dehydration and shock. This was a retrospective chart review of all cases of AGE with severe dehydration and shock admitted to the PICU from 2012 to 2017. Children who died during hospital stay were compared with those who survived. A total of 62 children were admitted with AGE to the PICU during this period. Twenty-four children (39%) died. The following variables were found to be significantly associated with death on univariate analysis: clinical pallor (p = 0.01), thrombocytopenia (p = 0.018), elevated leucocyte count (p = 0.02), hypoalbuminemia (p = 0.02) and severe acute malnutrition (SAM) (p = 0.04). On multivariate analysis, only hypoalbuminemia {RR [95% CI: 2.6 (1.27 to 9.21)]; 0.039} and SAM {RR [95% CI: 4.9 (1.12 to 10)]; 0.045} remained statistically significant. Children admitted with severe dehydration and shock had high mortality rates. These children were a sicker subset with probable sepsis. Severe acute malnutrition and hypoalbuminemia were associated with increased risk of death in these patients.

Bacterial etiology and antibiotic resistance pattern of neonatal sepsis: a study in a tertiary care hospital, in Bangladesh

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. The objective of the study was to detect causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns.Methods: This prospective cross-sectional study was conducted from July 2017 to June 2018 in the Department of Neonatal Medicine and NICU of Dhaka Shishu (Children) Hospital (DSH). Neonates diagnosed with probable sepsis were studied. After enrollment, 1 mL blood was taken and sent to Microbiology department of DSH for culture and sensitivity. With baseline characteristics, clinical examination findings and outcome, were also recorded.Results: Rate of isolation of single organism was 9.2% (84/913). Out of 84 isolates, gram negative bacteria were 77.4% with Klebsiella pneumonae being the commonest (35, 41.7%), gram positive bacteria were 11.9% with Staphylococcus aureus and Streptococcus were equal (5, 5.95% each) and the remaining (9, 10.7%) isolated organism was Candida. Most of the isolated gram-negative bacteria were resistant to ampicillin, gentamicin, and ceftazidime; but gram-positive bacteria preserved 20-80% sensitivity. Klebsiella was more resistant than Acinetobacter to amikacin, netilmicin, ciprofloxacin and levofloxacin. Around 45-65% of gram-negative bacteria were resistant to imipenem and meropenem but gram-positive bacteria showed lesser resistance. Among the gram-negative bacteria, Klebsiella and Acinetobacter were resistant to piperacillin as same as carbapenem group, but gram-positive bacteria were 100% sensitive to piperacillin. All the gram-negative bacteria showed more resistance to 4th generation cephalosporin, cefepime than carbapenem. Out of culture positive 84 neonates, 63 (75.0%) were cured but 21 (25.0%) died. Among the 21 expired neonates, 47.6% (10/21) were infected with Klebsiella.Conclusion: This study observed that gram-negative bacteria causing neonatal sepsis predominantly, with emergence of Candida. All the isolated gram-positive and gram-negative organisms were mostly resistant to available antibiotics

Diagnostic efficacy of sepsis-screen parameters (individual and combined) compared to blood culture and clinico-etiological profile of neonatal sepsis in preterm newborns

Introduction: Sepsis alone or along with other morbidity is the major contributor to mortality in both preterm and term babies accounting for more than a third of neonatal deaths in developing countries. Overall incidence of early onset sepsis (EOS) is higher in preterms and very low birth weight babies. Sepsis and related mortality is largely preventable with rational antimicrobials plus supportive therapy after timely detection of clinical sepsis, risks, complications, and with help of early screening laboratory-markers. Material and Method: This was a prospective, observational, hospitalbased study to compare the efficacy between various sepsis-screening tests & blood culture in early diagnosis of neonatal sepsis in preterms, conducted in NICU at Pt. JNM Medical College, Raipur, conducted during April 2018-September 2018. By using statistical Sample-size formula, 125 preterm neonates were enrolled. Detailed history and clinical findings were recorded on a predesigned proforma. All five sepsis-screen tests were done within 24 hours of birth or at clinical presentation before starting antibiotics, for all preterms at risk of EOS (based on neonatal/maternal risk factors>3) and/or developing clinical sepsis. Data was compiled, tabulated and analyzed using Microsoft-SPSS version20. Result: Out of 125 patients, all were preterm 1500g. Out of all sepsis-suspect and at risk cases, EOS risk factors (>/=3 of maternal plus neonatal risks) was present in 47.2%, while EOS was suspected at admission in 83.2% cases on clinical ground. Overall sepsis screening was positive (>=2 parameters) in 40% of all subjects [24% having only 2, 10.4% having 3 and 5.6% having 4 tests positive], though >50%cases had single test positive (considered screen-ve). Although >88%cases developed clinical sepsis (EOS+LOS), only 40% were detected by screen positive (as probable sepsis), and 35.2% were blood culture positive (proven sepsis). Conclusion: The combinations of sepsis makers yielded better diagnostic results than single tests and proved to be a valuable aid for early diagnosis of neonatal sepsis in preterms along with blood culturesensitivity.

Impact of serum level of vitamin D on term neonates with early onset sepsis

AbstractBackground: Neonatal sepsis a major health challenge associated with major morbidity and mortality. Neonatal care improved recently. However, different challenges regarding management still exist. Vitamin D deficiencies was proposed as a predictor of neonatal sepsis. Objective: To highlight the impact of vitamin D levels on early onset sepsis in full term neonates.Methodology: It is a case control which carried out at the neonatal intensive care unit of Al-Azhar university hospital (Damietta), from March to April 2019. It included 50 full-term neonates with probable sepsis and 50 healthy controls of matched age and sex with no signs of sepsis.Results: vitamin D level showed significant negative correlation with sepsis, C-reactive protein (CRP), positive blood cultures; and significant positive correlations with Apgar score, hemoglobin concentration and platelets count. Regression analysis revealed that, higher CRP and lower vitamin D were associated risks of neonatal sepsis in univariate analysis. Multivariable regression analysis revealed that only lower vitamin D level is the predictor for early neonatal sepsis.Conclusion: Vitamin D levels were significantly lower in septic neonates with high sensitivity and specificity. Vitamin D supplementation to mothers during pregnancy could prevent early onset neonatal sepsis.

Disease burden of neonatal invasive Group B Streptococcus infection in the Netherlands.

BackgroundGroup B Streptococcus (GBS) is the leading cause of neonatal sepsis and meningitis worldwide. We aimed to estimate the current burden of neonatal invasive GBS disease in the Netherlands, as a first step in providing an evidence base for policy makers on the potential benefits of a future maternal GBS vaccine.MethodsSurveillance of neonatal invasive GBS occurs at the National Reference Laboratory for Bacterial Meningitis, where culture isolates from cerebrospinal fluid and blood are sent by diagnostic laboratories. From the number of cultures we estimated the incidence of neonatal (age 0–90 days) GBS meningitis and sepsis. We constructed a disease progression model informed by literature and expert consultation to estimate the disease burden of neonatal invasive GBS infection. As many neonates with a probable GBS sepsis are never confirmed by blood culture, we further estimated the disease burden of unconfirmed cases of probable GBS sepsis in sensitivity analyses.ResultsAn estimated 97 cases and 6.5 deaths occurred in the Netherlands in 2017 due to culture positive neonatal invasive GBS infection. This incidence comprised 15 cases of meningitis and 42 cases of sepsis per 100.000 births, with an estimated mortality of 3.8 per 100.000 live births. A disease burden of 780 disability-adjusted life years (DALY) (95% CI 650–910) or 460 DALY per 100.000 live births was attributed to neonatal invasive GBS infection. In the sensitivity analysis including probable neonatal GBS sepsis the disease burden increased to 71 cases and 550 DALY (95% CI 460–650) per 100.000 live births.ConclusionIn conclusion, neonatal invasive GBS infection currently causes a substantial disease burden in the Netherlands. However, important evidence gaps are yet to be filled. Furthermore, cases of GBS sepsis lacking a positive blood culture may contribute considerably to this burden potentially preventable by a future GBS vaccine.

A study of survival of very low birth weight neonates in a tertiary care hospital

Background: Preterm birth is one of the major clinical problems in Obstetrics and Neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. Very low birth weight (VLBW) neonates comprise between 4-8% of live-births but about one-third of deaths during the neonatal period occur in this group of newborns. Data on the probability of survival of infant in high risk pregnancies can be of great value in guiding management. The objective is to study the survival at discharge of VLBW neonates admitted in a tertiary care hospital.Methods: Retrospective observational study of all VLBW infants admitted in Aditya Hospital NICU over 3 years between 1-7-2011 to 30-6-2014. Descriptive and inferential statistical analysis has been carried out in the present study.Results: In the present study maternal PROM was seen in 32.9% of cases, Preeclampsia in 31.7% of cases which constituted the most important antenatal risk factor for VLBW followed by multiple gestations in 25.2%. Common morbidities in VLBW neonates are Neonatal jaundice, Probable sepsis, Apnea of prematurity and RDS. Survival improved with increasing gestational age and weight.Conclusions: Birth weight and gestational age specifically predicts survival of preterm VLBW babies, facilitating decision making for obstetricians, neonatologists and parents. In the present study total survival rate was 86.6% with a mortality of 13.4%.

Aetiological profile of fever in neonatal and paediatric population in hospital setting

Background: Febrile illness in children is a common cause of admission to hospital globally, with significant associated morbidity and mortality. Dengue, malaria, scrub typhus, typhoid and leptospirosis have been identified as major causes of acute undifferentiated febrile illness in Thailand, Malaysia, and Nepal. Climate variation, over population and urbanization may all contribute to the emergence and reemergence of infections in tropical regions like Tamil Nadu. The objectives of this study were to describe the aetiology of fever in hospitalized neonatal and Pediatric population. A descriptive study was designed.Methods: A prospective observational study was conducted. All children from 0 to 18 years admitted as in-patients. Sample size was calculated to be 650. Basic laboratory tests were done in all cases.Results: Out of a total of 650 children maximum number (40.7% n=265) of patients had short duration of fever between 1 to 3 days. Majority (56%) of patients had temperature between 100.4 to 101F. Only 5 children were confirmed to have malaria. Maximum number of pus cells found was 80 to 100 in 3 children in urine examination. Total Infectious cases were 631 (97.07%).Conclusions: Infectious aetiology was more common than non-infectious aetiology. Among all aetiologies, viral fever particularly dengue was the most common aetiology. Enteric fever was the second most common infectious cause of fever after viral fever. Short febrile illness (1 to 5 days) was the most common type of fever in children admitted in hospital. In neonates, the most common cause of fever was probable sepsis followed by dehydration fever.

Factores de riesgo para sepsis neonatal temprana en el Hospital Hermilio Valdizán Medrano. Huánuco, Perú. 2016

Objetivo: Determinar los principales factores de riesgo asociados a sepsis neonatal probable temprana. Metodología: Se realizó un estudio de tipo observacional, analítico, retrospectivo de casos y controles. Los casos fueron 71 recién nacidos diagnosticados con sepsis probable temprana asociado a uno o más de los factores en estudio; y el grupo de controles: 71 neonatos sin sepsis neonatal probable temprana con uno o más de los factores en estudio, los datos fueron recogidos de las historias clínicas. El análisis bivariado de los factores de riesgo evaluados, el bajo peso al nacer, infección del tracto urinario materno en el tercer trimestre y rotura prematura de membrana, se realizó a través de la prueba de Chi-2, Odds ratio con un nivel de confianza al 95%. Para el análisis comparativo de las variables cuantitativas se utilizó la prueba U de man whitney. Resultados: En el análisis bivariado se identificaron como factores de riesgo a la infección del tracto urinario materno (OR = 2,515, 95% IC = 1,246 – 5,075, p=0,00), bajo peso al nacer (OR=3,5, 95% IC= 1,65-7,84, p=0.01), la ruptura prematura de membranas no resultó estadísticamente significativa (OR=0,7, 95%IC=0,31-1,7) Conclusiones: La infección del tracto urinario y el bajo peso al nacer fueron los factores de riesgo más importantes en este estudio para el desarrollo de sepsis neonatal probable temprana.

Gastric Aspirates Gram Stain in Early Detection of Neonatal Sepsis

The aim of this study to evaluate role value of gastric aspirate gram stain as an early marker for diagnosis of neonatal sepsis in comparison with C-reactive protein and total white blood cell counts. The sample were taken from neonates admitted to the neonatal wards in Tikrit Teaching Hospital who were clinically diagnosed as sepsis. The study includes 50 cases each one was assessed clinically by prepared questionnaire including history, clinical assessment and laboratory parameters includes gastric aspirate, C-reactive protein (CRP) and total WBC count were done for all cases. Results revealed that, the number of probable sepsis was higher in males 30 (60%) than in females 20 (40%). Among all clinical manifestations, poor feeding had the highest proportion 39 (78%). Only 18 (36%) neonates were normal birth weight, while 32 (64%) were low and very low birth weight. Study of maternal risk factors revealed that the most frequent factor was maternal infection 30 (60%). In relation to positive results of investigations the cases with positive gram stain were more than cases with positive CRP and abnormal WBC count. The results of gastric aspirate showed that 19 (38%) of samples were positive.

Current Scenario of Neonatal Sepsis in West U.P

Background: Sepsis is a significant cause of morbidity and mortality in neonates. Babies born with weight which is ≤2500 grams and those who are born prematurely are the main victims of neonatal sepsis. Early and prompt diagnosis is very crucial for intact survival. Clinical symptoms alone cannot be taken as a criteria to diagnose neonatal sepsis. Thus, for early diagnosis of neonatal sepsis, in addition to clinical signs and symptoms, a test is required which is easy, affordable and rapid. Materials and Method: A cross sectional study was done between March, 2017 and May, 2018 in the Department of Pediatrics, S.N. Medical College, Agra. Before giving the first shot of antibiotic, blood samples of neonates were obtained by peripheral venous puncture under strict aseptic precautions and were evaluated for serial C- Reactive protein levels and complete blood counts. Blood culture were sent in all suspected sepsis neonates. Results: Among total 58 suspected sepsis cases, 22 and 36 were females and males respectively; 8 neonates were Extremely Low Birth Weight, 14 were Very Low Birth Weight, 17 were Low Birth Weight &amp; 19 were of normal birth weight; 38 and 20 neonates were preterm and term respectively; 21 presented within 72 hours of birth while 37 neonates were of Late onset sepsis. C-Reactive Protein were positive in 70.6% cases initially and 86.2% cases were positive after 24 hours. 19 were found to be proven culture positive. Conclusion: Serial C-Reactive Protein measurement is a better indicator of neonatal sepsis. In addition to clinical signs and symptoms and presence of neonatal and maternal risk factors, serial C-Reactive Protein should be used to detect early and late neonatal sepsis. Probable sepsis cases should always be confirmed with blood culture.

Osteopetrosis Presenting with Neonatal Thrombocytopenia: A Case Report

Background: Osteopetrosisis an inherited and rare bone disease, characterized by the impairment ofbone modeling and remodeling and the failure of osteoclasts to resorb bone. It also results in skeletal fragility despite increased bone mass, and may cause hematopoietic insufficiency, disturbed tooth eruption, nerve entrapment syndromes, and growth impairment. The infantile form of the disease is the most severe one with a poor prognosis. If untreated, it will result in death by the first decade of life. Case report: A term 10-day-old female neonate with a birth weight of 2850 grams delivered by caesarian section was reported without a history of parents' consanguinity from a healthy, gravida 2, para 1, abort 1 mother with no complication during pregnancy. The newborn admitted to the neonatal ward due to diffuse petechiae, purpura on the skin, and periorbital ecchymosis (raccoon eyes), without any other abnormal significant signs and symptoms. In laboratory findings except for frequent low platelet count as low as 10000-25000, there wasn’t any other abnormalities. Other coagulative tests were within normal ranges. In addition to antibiotics for probable sepsis, platelet transfusion was considered as the treatment, and due to the lack of proper response to the treatment, with suspicious of alloimmune thrombocytopenia, two courses of IV IgG were administered. Eventually, the persistent thrombocytopenia in spite of mentioned treatment led to further investigation , and finally osteopetrosis was diagnosed by the result of brain CTS. The patient was discharged from the hospital with a moderate thrombocytopenia while she needed frequent platelet transfusion. Eventually with bone marrow transplantation, the sign and symptoms of the disease subsided. Conclusion: In persistent and unjustifiable neonatal thrombocytopenia, diagnosis of osteopetrosis should be considered.

Outcome of Infants with Therapeutic Hypothermia after Perinatal Asphyxia and Early-Onset Sepsis

Background: Animal models suggest that neuroprotective effects of therapeutic hypothermia (TH) after perinatal asphyxia are reduced in infants with early-onset sepsis. Objectives: To assess the outcome of infants with perinatal asphyxia, neonatal encephalopathy, and TH in the presence of early-onset sepsis. Methods: In a retrospective cohort of 1,084 infants with perinatal asphyxia and TH, the outcome of 42 infants (gestational age 36.1–42.6 weeks and birth weight 2,280–5,240 g) with proven sepsis (n = 14) and probable sepsis (n = 28) was analyzed. Death, cerebral palsy, or a delayed development at 2 years was considered an adverse outcome. Results: Sepsis was caused mostly by group B streptococci (n = 17), other Gram-positive bacteria (n = 5), and Candida albicans (n = 1). Of the 42 infants, 9 (21.4%) died, and 5 (11.9%) showed impairments on follow-up. The outcome is comparable to the previously reported outcome of infants with TH without early-onset sepsis. Conclusion: A good outcome was reported in the majority of infants with perinatal asphyxia, TH, and early-onset sepsis. Cooling should not be withheld from these infants.