Rates Of Neonatal Sepsis Research Articles

Prediction model for early diagnosis of late-onset sepsis in preterm newborns.

Late-onset neonatal sepsis has a high mortality rate in premature infants. To date, no single test in the evaluation of neonatal sepsis has been demonstrated to be both sensitive and specific enough to assist in timely decision making. The aim of our study is to develop a predictive model that can be applied to all premature babies, using clinical and laboratory findings in premature babies, to recognize late-onset neonatal sepsis. 65 premature patients diagnosed with culture-proven late-onset neonatal sepsis and hospitalized in Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital neonatal intensive care unit between January 2018 and December 2020, and 65 premature newborns of similar age and gender who did not have sepsis were included in the study retrospectively. In our study, feeding difficulties, worsening in clinical appearance and fever were found to be significant among clinical findings, while thrombocytopenia and high C-reactive protein among laboratory findings are the strongest data supporting late-onset neonatal sepsis. In multiple regression analysis, thrombocytopenia, mean platelet volume, C-reactive protein, lymphocyte count and feeding difficulties had the highest odds ratio (p < 0.05). By converting these data into a scoring system, a nomogram was created that can be easily used by all clinicians. In our study, we developed a scoring system that can be easily applied to all premature patients by evaluating the clinical and laboratory findings in late-onset neonatal sepsis. We think that it will help in recognizing late-onset neonatal sepsis and strengthening the treatment decision. Predicting the individual probability of sepsis in preterm newborns may provide benefits for uninfected newborns to be exposed to less antibiotics, not to be separated from mother and baby, and to reduce healthcare system expenditures. The nomogram can be used to assess the likelihood of sepsis and guide treatment decision.

Clinical Profile and Outcome of Twin Babies Delivered at a Tertiary Care Center in Eastern Nepal

Introduction: Twin pregnancies are often associated with higher risks of complications for both the mother and the neonates, particularly in resource-limited settings. This study was conducted at a tertiary care center in Eastern Nepal to assess the clinical profile and outcomes of twin pregnancies. Methods: A descriptive cross-sectional study was carried out in the department of Pediatric and neonatology at Nobel Medical College Teaching Hospital, Biratnagar, Nepal over the period of 6 month (December 2023 to May 2024). Total of 32 twin pregnancies of gestational age of ≥28 weeks, where both twins were alive at delivery were included. Data were collected on maternal and neonatal characteristics, including birth weight, gestational age, Apgar scores, and clinical outcomes. Statistical analyses were performed to compare the outcomes between the first and second twins. Results: In the present, study total of 32 eligible twin were analyzed. The majority of twins were (53.1%) delivered between 32 to &lt;37 weeks of gestation rest 46.87% delivering between 28 to &lt;32 weeks. The average Apgar scores were 6.5 at 1 minute and 8.6 at 5 minutes. The most common clinical feature seen in twin neonates was lethargy which was seen in 32 neonates (50%). NICU admission was required for 70.3% of the neonates. There were no significant differences between groups twin 1 and twin 2 in most health indicators, such as clinical symptoms, hemoglobin, PCV, serum calcium level, jaundice, TTTS, chest X-ray findings, NICU admissions, or overall outcomes (P &gt; 0.05). However, twin 1 had a higher rate of neonatal sepsis (P = 0.048). notable difference was observed in the incidence of neonatal sepsis between the first and second twins, with the first twin being more affected. Neonatal mortality rate in twin in the present study was 7.8%. Conclusion: Twin pregnancies have high incidence of preterm delivery and low birth weight. Requirement of NICU care is more in case of first twin.

Phenotypic bacterial epidemiology and antimicrobial resistance profiles in neonatal sepsis at Jimma medical center, Ethiopia: Insights from prospective study.

Epidemiological profiles and the rundown crisis of antimicrobial resistance from bacterial isolates in neonatal sepsis compel regular surveillance to enhance data-driven decision-making. Accordingly, this study aimed to assess the phenotypic epidemiology and antimicrobial resistance profiles of bacteria isolated from clinically suspected neonatal sepsis in Ethiopia. A total of 342 neonates suspected of clinical sepsis were randomly included in a prospective observational study conducted at the neonatal intensive care unit (NICU) of Jimma medical center (JMC) from May 2022 to July 2023. Blood samples were collected from each neonate and subjected to a culture test for identification of bacterial isolates and their antibiotic resistance profiles following the standardized guidelines. The laboratory results, along with relevant clinical data, were recorded using WHONET and analyzed using STATA software. Out of the 342 blood samples that were analyzed, 138 samples (40.4%, 95% CI: 35.1-45.6, P<0.01) exhibited proven bacterial infection. The infection rates were notably higher in males with 85/138 (61.6%, 95% CI: 53.4-69.8, P<0.01) and neonates aged 0-3 days with 81/138 (58.7%, 95% CI: 50.5-66.9, P<0.01). The majority of the infections were attributed to Gram-negative bacteria, accounting for 101/138(73.2%, 95% CI: 65.6-80.7) cases, with 69/101(68.3%, 95% CI: 63.8-72.8) cases involving ESBL-producing strains, while Gram-positive bacteria were responsible for 26.8% (95% CI: 19.3-34.4) of the infections. The predominant isolates included Klebsiella pneumoniae (37.7%, 95% CI: 29.6-45.8), Coagulase-negative Staphylococci (CoNs) (20.3%, 95% CI: 13.6-27.0), and Acinetobacter species (11.6%, 95% CI: 6.0-17.1). Of the total cases, 43/72 (59.7%, 95% CI: 48.4-71.1, P<0.01) resulted in mortality, with 28/72 (38.9%, 95% CI: 27.70-50.1, P<0.03) deaths linked to Extended-Spectrum Beta-Lactamase (ESBL)-producing strains. Klebsiella pneumoniae displayed high resistance rates to trimethoprim-sulfamethoxazole (100%), ceftriaxone (100%), cefotaxime (98.1%), ceftazidime (90.4%), and gentamicin (84.6%). Acinetobacter species showed resistance to ampicillin (100%), cefotaxime (100%), trimethoprim-sulfamethoxazole (75%), ceftazidime (68.8%), chloramphenicol (68.8%), and ceftriaxone (68.8%). Likewise, CoNs displayed resistance to ampicillin (100%), penicillin (100%), cefotaxime (86.0%), gentamicin (57.2%), and oxacillin (32.2%). Multidrug resistance was observed in 88.4% (95% CI: 81.8-93.0) of isolates, with ESBL-producers significantly contributing (49.3%, 95% CI: 45.1-53.5). Furthermore, 23.0% (95% CI: 15.8-31.6) exhibited a prevalent resistance pattern to seven distinct antibiotic classes. The prevalence and mortality rates of neonatal sepsis were significantly high at JMC, with a notable surge in antibiotic and multidrug resistance among bacterial strains isolated from infected neonates, specifically ESBL-producers. These resistant strains have a significant impact on infection rates and resistance profiles, highlighting the requisite for enhanced diagnostic and antimicrobial stewardship, stringent infection control, and further molecular characterization of isolates to enhance neonatal survival.

Factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Rwanda

More than one million neonatal deaths occur every year worldwide, of which 99% take place in low-income countries. In Rwanda, nearly 71% of neonatal deaths are preventable and among these, 10% are due to neonatal sepsis. Nevertheless, limited information exists on neonatal sepsis and its associated factors in Rwanda. The objectives of the study were to find prevalence and factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Ngoma District, Rwanda. We used a retrospective cross-sectional study design reviewing a subset of neonatal, maternal and laboratory records from Kibungo Hospital in 2017. Data were reviewed and collected from March to May, 2018. Logistic regression and odds ratios were calculated to identify the factors associated with neonatal sepsis at 95% CI, p < 0.05. Of the 972 total neonates’ medical records from 2017, we randomly selected 422 of which 12.8% (n = 54) had neonatal sepsis. When blood cultures were positive, 62% grew Klebsiella pneumoniae. Among neonates with sepsis, 38 (70%) recovered while 16 (30%) died. Neonatal sepsis was strongly associated with neonatal age less than or equal to three days (aOR: 2.769, 95% CI 1.312–5.843; p = 0.008); and gestational age less than 37 weeks (aOR: 4.149; CI 1.1878–9.167; p ≤ 0.001). Increased use of blood cultures including sensitivity testing, routine surface cultures of the neonatology and maternity wards facilities, and systematic ward cleaning are all important approaches to prevent and treat neonatal infections in additional to regular neonatal sepsis evaluations.

Support breastfeeding in premature infants in the neonatal intensive care unit

The multiple benefits of human milk in newborns are known, especially in preterm newborns by reducing the rates of neonatal sepsis, necrotizing enterocolitis, retinopathy of prematurity and better results in neurodevelopment. However, rates of exclusive breast milk use remain low. To achieve higher percentages of successful breastfeeding, strategies must be applied from the NICU, such as expressed within the first 6 hours of life, skin-to-skin contact and administration of colostrum in the cheeks, all well, in order to have sufficient volume of breast milk since this is the main barrier they face, not having enough milk. There are very few studies that evaluate when to initiate suctions directly to the maternal breast, using the empty breast as non-nutritive suction could improve the performance of VLBW to the maternal breast.

Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics.

This study aimed to examine whether the addition of latency antibiotics in late preterm rupture of membranes (ROM) decreases neonatal infection and increases latency. This retrospective two-center study was conducted at Holy Family Hospital (HFH) in Nazareth and Emek Medical Center (EMC) in Afula, on data collected between January 2017 and April 2023. HFH is the smaller institution. EMC and HFH implement similar policies regarding ROM at 340/7 to 366/7 weeks' gestation; the only difference is that a 10-day course of latency antibiotics is implemented at EMC. All women with ROM between 340/7 and 366/7 weeks' gestation who were admitted to one of the centers during the study period, and had a live fetus without major malformations, were included. The primary outcome was neonatal sepsis rate. Secondary outcomes included a composite of neonatal sepsis, mechanical ventilation ≥24 hours, and perinatal death. Additionally, gestational age at delivery and delivery mode were examined. Overall, 721 neonates were delivered during the study period: 534 at EMC (where latency antibiotics were administered) and 187 at HFH. The gestational age at ROM was similar (35.8 and 35.9 weeks, respectively, p = 0.14). Neonatal sepsis occurred in six (1.1%) neonates at EMC and one (0.5%) neonate at HFH (adjusted p = 0.71; OR: 1.69; 95% Confidence Interval [CI]: 0.11-27.14). The composite secondary outcome occurred in nine (1.7%) and three (1.6%) neonates at EMC and HFH, respectively (adjusted p = 0.71; OR: 0.73; 95% CI: 0.14-3.83). The gestational age at delivery was 36.1 and 36.2 weeks at EMC and HFH, respectively (mean difference: 5 h; adjusted p = 0.02). The cesarean delivery rate was 24.7% and 19.3% at EMC and HFH, respectively (adjusted p = 0.96). Latency antibiotics administered to women admitted with ROM between 340/7 and 366/7 weeks' gestation did not decrease the rate of neonatal sepsis. · Latency antibiotics in late preterm ROM does not decrease neonatal sepsis.. · Latency antibiotics in late preterm ROM does not prolong gestational age at delivery.. · Latency antibiotics in late preterm ROM does not affect the mode of delivery..

Assessment of the prevalence of meningitis in clinically suspected cases of early and late onset neonatal sepsis

Background: Meningitis is more common in the neonatal period than any other time in life and is an important cause of morbidity and mortality globally. In India, rate of neonatal sepsis is reported 0.5 per 1000 live births. The major burden of neonatal sepsis and meningitis occurs in the developing world. According to WHO estimates there are approximately 5 million neonatal deaths in a year. The objective of the study is to assess the prevalence of meningitis in neonates with clinical suspicion of sepsis. Methods: The study was conducted among suspected cases of neonatal septicemia in neonatal intensive care unit (NICU), department of pediatrics, VPIMS, Lucknow. It is a prospective observational study. A total of 180 neonates were included in the study. Results: Out of 180 neonates, CSF examination of 131 (72.78%) neonates was normal, of 37 (20.56%) was suggestive of meningitis. Prevalence of meningitis in neonatal sepsis was 20.0%. It was 18.0% in early neonatal sepsis and 32.6% in late neonatal sepsis cases. Conclusions: The findings of present study suggested that there is a high risk of meningitis among neonatal sepsis cases. Cases with risk factors like twin birth, anemia, low TLC, low platelet count, acid-base imbalance and X-ray findings suggestive of pneumonitis should be kept in a high-risk category.

Epidemiologic features of neonatal sepsis and its COVID-19 associated temporal patterns in Jimma Medical Center, Ethiopia: A Joinpoint regression analysis.

Neonatal sepsis remains a leading cause of morbidity and mortality in neonates across all regions, including Africa. Compared to developed and some developing countries, there are relatively few epidemiological trends for neonatal sepsis and associated patterns with COVID-19 in Ethiopia. We modeled an epidemiological trend and pattern to aid in the monitoring of changes in neonatal sepsis. Retrospective data were collected from all admissions to the Neonatal Intensive Care Unit (NICU) in Ethiopia at Jimma Medical Center between May 2019 and April 2022. We analyzed the monthly neonatal sepsis incidence, mortality, and case-fatality rates using STATA software. Finally, we modeled a monthly time series of neonatal sepsis incidence trends and patterns associated with the COVID-19-impacted period using Joinpoint software. For all analyses, a P value of 0.05 was considered statistically significant at the 95% confidence interval (CI). In the 36 months, 6796 cases were admitted to the NICU, with a 9.5% (95% CI: 9.1, 10.0) incidence rate of neonatal sepsis. The overall admission mortality rate was 16.5% (95% CI: 13.6, 19.8), while sepsis-attributed mortality was 7.1% (95% CI: 5.8, 8.5). The data showed an unstable decreasing trend for three Joinpoints (August 2020, December 2020, and August 2021). Notably, a decrease in the incidence trend was observed from May 2019 to August 2020 (MPC, -4.1; 95% CI: -7.6, -0.5; P = 0.03), followed by a sharp increase (MPC, 23.7; 95% CI: -13.8, 77.7; P = 0.24) from August 2020 to December 2020. From December 2020 to August 2021, there was again a decreasing trend (MPC, -13.8; 95% CI: -23.3, -3.5; P = 0.01), followed by a slight increase from August 2021 to April 2022 (MPC, 4.2; 95% CI: -8.4, 18.6; P = 0.52). Finally, the study revealed an association between patterns of neonatal sepsis incidence trends and COVID-19, with a Joinpoint jump model comparability ratio (CR = 0.43) between pre- and COVID-19-impacted periods. Neonatal sepsis was prevalent at Jimma Medical Center, but it was on an unstably declining trend. The current results suggest a potential temporal association between the intensity of COVID-19 containment measures and a change in the incidence trend and patterns of neonatal sepsis. However, the quantified contribution of a particular containment measure requires further investigation.

Comparing Obstetric and Perinatal Outcomes Following Elective and Emergency Cervical Cerclage in Singleton and Multiple Pregnanciesin a Tertiary Care Perinatal Centre.

To compare the success, failure rates and perinatal outcomes following emergency and elective cervical cerclage in singleton and twin pregnancies at a tertiary care perinatal centre over half a decade. All pregnant women, both with singleton and twin pregnancies, who had cervical cerclage between June 2014 and May 2019were included in the retrospective study. Success rates, failure rates, maternalcomplications and perinatal outcomes were compared in both groups. There were 129 women enrolled in the study, 48 in the emergency and 81 in the elective group. A significantly greater number of multiparous women werein the elective group (97.5% versus 68.7%; p-value < 0.001). Twins were nearly four times more in the emergency group as compared tothe elective group. The mean cervical length at time ofcerclage was 2.05cm and 1.5cm; (p-value < 0.001) respectively in the elective and emergency groups. Almost half of the women in the emergency group hadbulging membranes. (52.2%). Following cerclage, mean gestational age at delivery was similar in both groups. However, more women in the elective group delivered at or beyond 34weeksin comparison to the emergency groups (71% versus 53.3%. P-value 0.05). Preterm labour leading to preterm births wasalmost twice in the emergency groupthan elective group (49% versus 22%, P-value 0.002). Rates of maternal chorioamnionitis were similar in both groups. Theoverall live birth rates were comparable (81.3% versus 84.4% P-value 0.85) in boththe groups. These results were also seen on doing subgroup analysis of elective versus emergency cerclage in singleton pregnancies only. Failure rates were also similar in both groups (18.7% versus 15.6%, P-value 0.85) Composite neonatal morbidity was more in the emergency group than in the elective group (35.5 versus 14%, P-value 0.01). Live birth rates and failure rates were comparable following elective and emergency cerclageboth overall and in singleton pregnancies. Maternal chorioamnionitis and neonatal sepsisrates were similar in both the groups. However, composite neonatal morbidity was higher in the emergency cerclage group.

Understanding the Drivers Behind Neonatal Sepsis Rates among Immunized and Outpatient Neonates at Hoima Regional Referral Hospital, Western Uganda

Neonatal sepsis is a major cause of neonatal mortality in developing countries, accounting for a significant portion of annual infant deaths. This study investigated the determinants influencing the occurrence of neonatal sepsis among infants at Hoima Regional Referral Hospital in Western Uganda. The study revealed an overall neonatal sepsis prevalence of 12.5%, with 65% and 35% of cases classified as early-onset and late-onset sepsis, respectively. Factors significantly associated with neonatal sepsis included neonatal age, maternal history of fever, dysuria, and maternal/caretaker hygiene. The study emphasizes the importance of caretaker/mother's age, maternal fever history, dysuria, and hygiene in contributing to neonatal sepsis. Prevention strategies should prioritize addressing these risk factors rather than solely focusing on post-occurrence treatment. Proactive measures are advocated to mitigate the incidence of neonatal sepsis. Keywords: Neonatal sepsis, Immunization, Childhood mortality, Maternal/caretaker’s hygiene, maternal history of fever

Tailored Approach to Evaluation and Management of Early Onset Neonatal Sepsis in a Safety-Net Teaching Hospital in Northeast Florida.

Objective Early onset neonatal sepsis (EONS) remains a significant cause of morbidity and mortality in newborns in the immediate postnatal period. High empiric antibiotic use in well-appearing infants with known risk factors for sepsis led the American Academy of Pediatrics (AAP) to revise its 2010 guidelines for the evaluation and management of EONS to avoid overuse of antibiotics. In this recent clinical report, the AAP provided a framework that outlined several evidence-based approaches for sepsis risk assessment in newborns that can be adopted by institutions based on local resources and structure. One of these approaches, the sepsis risk calculator (SRC) developed by Kaiser Permanente, has been widelyvalidated for reducing unnecessary antibiotic exposure and blood work in infants suspected of having EONS. In order to determine the utility and safety of modifying our institution's protocol to the SRC, we implemented a two-phased approach to evaluate the use of SRC in our newborn nursery. Phase 1 utilized a retrospective review of cases with SRC superimposition. If results from Phase 1 were found to be favorable, Phase 2 initiated a trial of the SRC for a six-month period prior to complete implementation. Methods Phase 1 consisted of retrospectively applying the SRCto electronic medical records (EMR) of infants ≥ 35 weeks' gestational age admitted to the newborn nursery with risk factors for EONS between June 2016 and May 2017. We compared actual antibiotic use as determined by the unit's EONS protocol for evaluation and management based on 2010 Centers for Disease Control and Prevention (CDC) and AAP guidelines to SRC-recommended antibiotic use. We used EMR to determine maternal and infant data, blood work results, and antibiotic usage as well asused daily progress notes by the clinical team to determine the clinical status of the infants retrospectively. Based on the projected reduction in blood work and antibiotics use with the retrospective superimposition of SRC on this cohort of infants and identification of our high-risk patient subset, we developed a novel, hybrid EONS protocol that we implemented and assessed throughout Phase 2, a six-month period from August 2018 to January 2019, as a prospective observational study. Results Phase 1 (SRC superimposition) demonstrated that the use of the SRC would have reduced empiric antibiotic use from 56% to 13% in the study cohort when compared with 2010 CDC/AAP guidelines. However, these same findings revealed use of the SRC would have resulted in delayed evaluation and initiation of antibioticsin 2 of 4 chorioamnionitis-exposed infants with positive blood cultures. During Phase 2 (n=302), with the implementation of our tailored approach (SRC implementation with additional blood culture in chorioamnionitis-exposed infants), 12 (4%) neonates received empiric antibiotic treatment compared to nine (3%) neonates who would have been treated per strict adherence to SRC recommendations. No neonate had culture-positive EONS. Continued use of 2010 CDC/AAP guidelines would have led to empiric antibiotic use in 38 (12.6%) infants in this cohort. Conclusion We developed a novel hybrid approach to the evaluation and management of neonates at increased risk of EONS by tailoring SRC recommendations to our safety-net population. Our stewardship effort achieved a safe and significant reduction in antibiotic usage compared to prior usage determined using CDC/AAP guidelines.

Intrapartum azithromycin to prevent maternal and neonatal sepsis and deaths: A systematic review with meta-analysis.

A systematic review with met-analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths. PubMed, Scopus and Web of Science databases were searched in March 2023. Randomised controlled trials comparing intrapartum single-dose of azithromycin with placebo. Maternal infections, maternal mortality, neonatal sepsis, neonatal mortality. We used the random-effects Mantel-Haenszel method to calculate risk ratios (RR) with 95% confidence intervals (95% CI). We assessed risk of bias of the included studies and estimated the evidence certainty using the GRADE approach. After screening 410 abstracts, five studies with 44 190 women and 44 565 neonates were included. The risk of bias was low in four and had some concerns in one of the studies. The risk of endometritis was 1.5% in the azithromycin group and 2.3% in the placebo group (RR 0.64, 95% CI 0.55-0.75), and the evidence certainty was high. The respective risk for chorioamnionitis was 0.05% and 0.1% (RR 0.50, 95% CI 0.22-1.18; evidence certainty moderate). The wound infection rate was lower in the azithromycin group (1.6%) than in the placebo group (2.5%), RR 0.52 (95% CI 0.30-0.89; moderate certainty evidence). The maternal sepsis rate was 1.1% in the azithromycin group and 1.7% in the placebo group (RR 0.66, 95% CI 0.56-0.77; evidence certainty high). Mortality rates did not show evidence of a difference (0.09% versus 0.08%; RR 1.26, 95% CI 0.65-2.42; moderate certainty evidence). The neonatal mortality rate was 0.7% in the azithromycin group and 0.8% in the placebo group (RR 0.94, 95% CI 0.76-1.16; moderate certainty evidence). The neonatal sepsis rate was 7.6% in the azithromycin group and 7.4% in the placebo group (RR 1.02, 95% CI 0.96-1.09; moderate certainty evidence). Intrapartum administration of azithromycin to the mother reduces maternal postpartum infections, including sepsis. Impact on maternal mortality remains undecided. Azithromycin does not reduce neonatal sepsis or mortality rates.

Evaluation of the Diagnostic and Prognostic Potential of Circulating miR-34a in Neonatal Sepsis

Background Neonatal sepsis is a complex syndrome which is characterized by systemic inflammatory response. The high mortality rate of neonatal sepsis is contributed to late diagnosis and improper management. Aim of the Work The aim of this research is to examine the diagnostic utility of miR-34a in newborns with sepsis (who were newly diagnosed according to the clinical sepsis score and the hematology score of sepsis) and compare them to neonates without sepsis by using real-time PCR. Patients and Methods This study was conducted on 70 neonates from NICU of Ain Shams University hospital and permitted by Ain Shams ethical committee. Neonates were classified into two groups: 35 neonate with sepsis and 35 neonate without sepsis. In consideration, these neonates’ ages were ≥ 35 weeks, had no Congenital anomalies, Chromosomal abnormalities and had not been given any kind of antibiotics before obtaining blood specimens from them. Moreover, the study didn’ t include neonates with an inborn error of metabolism or any surgical procedures. Neonates without sepsis and neonates with sepsis were matched in terms of gender and age. In our study, blood samples of 2 ml were withdrawn from patients (within 72 hours from suspecting the diagnosis of neonatal sepsis) and from the control at matched gestation and postnatal ages, then patients were followed up. Results the obtained results showed that, the expression level of miR-34a was reduced by 5.2-fold in neonates with sepsis, with a P value of 0.001. Additionally, a negative correlation was detected between miR-34a expression level and either the clinical sepsis score (p = 0.163) and the hematology score (p = 0.122), and also a significant correlation was detected between the clinical sepsis and hematology scores in neonates with sepsis (p = 0.047). The study observed that, the miR-34a could discriminate neonates with clinical sepsis score, the biomarker sensitivity and specificity were 80% and 70%, respectively. In addition, the calculated sensitivity and specificity of miR-34a to discriminate neonates with hematology score were 85% and 87%; respectively. The cut-off value was &amp;lt;0.04 . Conclusion Based on the obtained results, there is a significant difference between the serum expression level of miR-34a and either the clinical sepsis score and hematology score . the lower expression level of miR-34a was detected in neonates with CSS &amp;gt;10. Similarly, the lower expression level of miR-34a was detected in neonates with high hematology score &amp;gt;4.

Interventions for the Prevention or Treatment of Epidural-related Maternal Fever: A Systematic Review and Meta-analysis

(British Journal of Anaesthesia. 2022;129:567e580) Epidural-related maternal fever (ERMF) occurs in 15% to 25% of laboring women who receive analgesia. ERMF is not seen in non-pregnant or pregnant women who are not in labor. The cause behind ERMF is not yet understood. There have been studies on a number of preventative interventions for ERMF. This systematic review aimed to compare the effectiveness of proposed interventions, primarily in terms of the incidence of ERMF, and secondarily, by comparing the incidence of neonatal sepsis evaluation and neonatal admission to level 2 care.

Traffic-related air pollution is associated with spontaneous extremely preterm birth and other adverse perinatal outcomes

Although there is growing awareness of the relationship between air pollution and preterm birth, limited data exist regarding the relationship with spontaneous preterm birth and severe neonatal outcomes. This study aimed to examine the association between traffic-associated air pollution exposure in pregnancy and adverse perinatal outcomes including extremes of preterm birth, neonatal intensive care unit admissions, low birthweight, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. This was a retrospective cohort study of singleton pregnancies of patients residing in a metropolitan area in the southern United States. Using monitors strategically located across the region, average nitrogen dioxide concentrations were obtained from the Environmental Protection Agency Air Quality System database. For patients living within 10 miles of a monitoring station, average exposure to nitrogen dioxide was estimated for individual patients' pregnancy by trimester. Logistic regression models were used to assess the effect of pollutant exposure on gestational age at birth, indicated vs spontaneous delivery, and neonatal outcomes while adjusting for maternal age, self-reported race, parity, season of conception, diabetes mellitus, body mass index, registered Health Equity Index, and nitrogen dioxide monitor region. Adjusted odds ratios and 95% confidence intervals were calculated for an interquartile increase in average nitrogen dioxide exposure. Between January 1, 2013 and December 31, 2021, 93,164 patients delivered a singleton infant. Of these, 62,189 had measured nitrogen dioxide exposure during the pregnancy from a nearby monitoring station. Higher average nitrogen dioxide exposure throughout pregnancy was significantly associated with preterm birth (adjusted odds ratio, 1.94; 95% confidence interval, 1.77-2.12) and an increase in neonatal intensive care unit admissions, low birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. This relationship persisted for nulliparous patients and spontaneous preterm birth, and had a greater association with earlier preterm birth. In a metropolitan area, increased exposure to the air pollutant nitrogen dioxide in pregnancy was associated with spontaneous preterm birth and had a greater association with extremely preterm birth. A greater association with neonatal intensive care unit admissions, low-birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation was found even in term infants.

Neonatal sepsis and its associated factors among neonates admitted to the neonatal intensive care unit in Wachemo University Comprehensive Specialized Hospital, Southern Ethiopia, 2022.

Neonatal sepsis is a major public health problem worldwide. It is one of the leading causes of neonatal mortality and morbidity worldwide. The neonatal mortality rate is higher in developing countries, where the extent and causes of neonatal sepsis are not yet known. Neonatal sepsis is a leading cause of neonatal mortality in Ethiopia. As a result, this study aimed to assess the proportion and identify maternal and neonatal risk factors for neonatal sepsis among neonates admitted to the neonatal intensive care unit. An institutional-based cross-sectional study was conducted from May 2022 to July 2022 at the Wachemo University Comprehensive Specialized Teaching Hospital, Neonatal Intensive Care Unit, southern Ethiopia. A total of 205 neonates with indexed mothers participated in the study. Using a consecutive sampling technique, a structured, pretested questionnaire was used to collect data from the study subjects. Data were entered into EpiData Manager version 3.1 for Windows and then exported to SPSS version 22 for further data cleaning and analysis. Descriptive analyses were performed by using frequency, percentage, and summary statistics to describe the key variables. A multivariate regression model was used to identify factors associated with neonatal sepsis. Finally, statistical significance was declared at a p-value of less than 0.05, and an adjusted odds ratio (AOR) with a 95% confidence level was used to declare the variable's association with the outcome variable. The overall prevalence rate of neonatal sepsis was 39.5% (95% CI: 33.7-45.9). Multivariable analysis was performed by taking a variable that is statistically significant in bivariate logistic regression as a candidate variable. Multivariable model analysis showed that unmarried status AOR = 18.37 (95% CI: 1.56-216.14), maternal fever during delivery AOR = 4.74 (95% CI: 1.63-13.8), and premature rupture of membrane AOR = 7.53 (95% CI: 2.19-25.6) were variables that increased the odds of developing neonatal sepsis. The study's findings indicate that neonatal sepsis is highly prevalent. Unmarried maternal status, maternal fever during delivery, and premature rupture of the membrane were predictors of neonatal sepsis. Therefore, providing training for health workers and close monitoring and evaluation during obstetric and neonatal care are crucial to halt the occurrence of neonatal sepsis.

Bacteriological Profile and Detection of β-Lactamase Producing Bacteria Isolated from Blood Samples of Neonates

The clinical impact of β-lactamase has become a public health problem around the world in terms of increased morbidity and mortality, especially in the child population. This study was aimed at determining the bacteriological profile and detection of β-lactamase producing bacteria isolated from the blood samples of neonates. For this study, a total of 1335 blood samples of neonates admitted in NICU, SCBU, and sepsis-suspected neonates visiting Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal were collected and processed. Blood culture was performed and the identification of bacteria was done by following standard microbiological methods. Antibiotic susceptibility testing was done by using the Kirby Bauer Disk Diffusion method and confirmation of ESBL, MBL, and KPC-producing bacteria was done by Combined Disk Test. The prevalence rate of neonatal sepsis was found to be 17%. K. pneumoniae 116 (50.2%) was the predominant Gram-negative bacteria followed by K. oxytoca 31 (13.4%) whereas S. aureus 39 (16.9%) was the predominant Gram-positive bacteria causing neonatal sepsis. Among 182 Gram-negative bacterial isolates, 69 (37.9%), 22 (12.1%), and 14(31.1%) were found to be ESBL, MBL, and KPC producers respectively. K. oxytoca (54.8%), Enterobacter spp. (25%) and Citrobacter spp. (14.3%) were the predominant ESBL, MBL, and KPC producers respectively. The co-production of ESBL, MBL, and KPC was also found among the 5 Gram-negative bacteria. Colistin, Meropenem, and Imipenem seem to be the choice of the drug against Gram-negative bacteria, whereas Vancomycin and Cefoxitin seem to be the choice of the drug against Gram-positive bacteria. Therefore, to lessen the burden of antibiotic resistance, it is essential to conduct regular antimicrobial susceptibility surveillance, periodic reviews of hospital settings, and early detection of beta-lactamase-producing bacteria. Int. J. Appl. Sci. Biotechnol. Vol 11(2): 66-77.

Relation of NLR Value and Mortality Rate in Neonatal Sepsis

&lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;: Neonatal sepsis is a significant issue for newborns everywhere and causes a large amount of morbidity and mortality. Various indicators of newborn sepsis are expensive and occasionally unavailable in peripheral hospitals. The neutrophil-lymphocyte ratio (NLR), which is affordable, is a component of complete blood counts and does not call for further testing. This study intended to investigate the neutrophil-to-lymphocyte ratio (NLR) as a predictor of neonatal mortality rate in the local hospital in rural locations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: This study sampled newborns with sepsis in the perinatal room of dr. Soebandi Hospital Jember for this cross-sectional study, from January 2021 to June 2022. NLR is calculated by manually dividing the number of neutrophils by the actual number of lymphocytes. Our neutrophil and lymphocyte data were obtained from the patient's lab results. This study analyzed neonatal sepsis NLR data using Spearman analysis to find the relation between NLR value and mortality rate of neonatal sepsis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: This study obtained 43 data on neonatal sepsis in the perinatology ward during this period. The data found to show that 37 neonatal sepsis survived and 6 died. The collected data analysis found that the lowest NLR neonatal sepsis is 0.4, the highest NLR neonatal sepsis is 25.6 and the mean value for NLR neonatal sepsis in perinatology was 3.88. This study found no correlation between the NLR value of the sepsis neonate and the neonatal mortality rate Sig. (2-tailed) 0.662.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: In this study demonstrated no correlation between the NLR value of the sepsis neonates and the neonatal mortality rate.&lt;/p&gt;

Risk of Neonatal Sepsis With Rescue Steroids in Preterm Premature Rupture of Membranes.

Objective To evaluate whether a rescue course of corticosteroids, when given at least 14 days after the initial course, is associated with an increased risk of neonatal sepsis after preterm premature rupture of membranes (PPROM). Methods We performed a retrospective, descriptive cohort study of women with singleton gestations from 23+0 to 34+0 weeks of gestation who received a rescue course of corticosteroids within the Indiana University Health Network from January 2009 through October 2016. Patients were separated into three groups based on amniotic membrane status at the time of each corticosteroid administration: Group 1 (intact membranes at initial/intact membranes at rescue), Group 2 (intact membranes at initial/PPROM at rescue), and Group 3 (PPROM at initial/PPROM at rescue). The primary outcome (neonatal sepsis) was compared between the groups. Patient characteristics and neonatal outcomes were analyzed with Fisher's exact test for categorical variables and ANOVA for continuous variables. Relative risk (RR) was calculated by comparing those with ruptured membranes to those with intact membranes at the time of rescue course administration. Results A total of 143 patients were eligible. Neonatal sepsis occurred in 6.8% of patients in Group 1, 21.1% of patients in Group 2, and 23.8% of patients in Group 3. Groups 2 and 3 had a statistically significant higher rate of neonatal sepsis than Group 1 (p = 0.021). The RR of neonatal sepsis after a rescue course in patients with PPROM (Groups 2 and 3) was 3.31 (95% CI = 1.32, 8.29) compared to those with intact membranes at the time of rescue course administration (Group 1). Conclusion A rescue course of corticosteroids in women with PPROM at the time of rescue administration was associated with an increased risk of neonatal sepsis. This increased risk was seen in women with intact membranes as well as ruptured membranes during their initial course of steroids. Larger studies are needed to further investigate this association.

Risk Factors Associated with Multi-Drug Resistance in Neonatal Sepsis Caused by Escherichia coli.

An increasing number of cases of neonatal sepsis due to extended-spectrum beta-lactamase (ESBL)-producing multi-drug resistant (MDR) Escherichia coli (E. coli) have been reported worldwide. The aim of this study was to explore the risk factors associated with ESBL-producing MDR E. coli among neonates with culture-confirmed E. coli sepsis and thereby to help selection of appropriate empirical antibiotics. All newborn infants with a confirmed pathogen isolated from blood or cerebrospinal fluid (CSF) from 2016 to 2021 were identified and those with E. coli infection were included in this analysis. We compared a group of neonatal patients with ESBL-producing MDR E. coli sepsis (n=69) to a group with ESBL-negative E. coli (n=70) based on antimicrobial susceptibility reports. We used multivariable regression analysis to determine the risk factors associated with ESBL-producing MDR E. coli strains among the neonates with culture-confirmed E. coli sepsis. ESBL-producing MDR E. coli sepsis was more common in premature infants and newborns with hospital-acquired late-onset sepsis (HALOS). The mortality rate of neonatal sepsis caused by ESBL-producing E. coli was about twice as that of sepsis caused by ESBL-negative E. coli. Antepartum exposure to cephalosporins (OR=25.191, 95% CI: 3.184-199.326, P<0.01) and parenteral nutrition for more than 1 week (OR=4.495, 95% CI: 2.009-10.055, P<0.01) were independent risk factors for neonatal infection with ESBL-producing stains among infants with E. coli sepsis. E. coli remains the most common Gram-negative bacterial pathogen causing neonatal sepsis. A higher proportion of ESBL-producing MDR E. coli is seen in premature infants and those newborns with HALOS and is associated with higher mortality. Antepartum use of cephalosporins and prolonged use of parenteral nutrition may be important factors to consider in the selection of empirical antibiotics for use in neonatal sepsis caused by gram-negative rods prior to the availability of the results of antimicrobial susceptibility.