Risk Factors For Early-onset Sepsis Research Articles

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.

Cord blood presepsin as a predictor of early-onset neonatal sepsis in term and preterm newborns

BackgroundTo date, no studies on presepsin values in cord blood of term infants with risk factors for early-onset sepsis (EOS) are available, whereas only one study reported presepsin values in cord blood of preterm infants at risk. In this study, we investigated the presepsin values in cord blood of term and preterm infants with documented risk factors for EOS.MethodsIn this single-center prospective pilot study, we enrolled neonates presenting with documented risk factors for EOS. P-SEP levels were assessed in a blood sample collected from the clamped umbilical cord after the delivery in 93 neonates, using a point-of-care device. The primary outcome of our study was to evaluate the role of cord blood P-SEP in predicting clinical EOS in term and preterm infants.ResultsDuring the study period, we enrolled 93 neonates with risk factors for EOS with a gestational age ranging between 24.6 and 41.6 weeks (median 38.0). The median P-SEP value in all infants was 491 pg/ml (IQR 377 – 729). Median cord P-SEP values were significantly higher in infants with clinical sepsis (909 pg/ml, IQR 586 – 1307) rather than in infants without (467 pg/ml, IQR 369 – 635) (p = 0.010). We found a statistically significant correlation between cord P-SEP value at birth and the later diagnosis of clinical sepsis (Kendall's τ coefficient 0.222, p = 0.002). We identified the maximum Youden’s Index (best cut-off point) at 579 pg/ml, corresponding to a sensitivity of 87.5% and a specificity of 71.8% in predicting clinical sepsis.ConclusionsMaximum Youden’s index was 579 pg/ml for clinical EOS using cord P-SEP values. This could be the starting point to realize multicenter studies, confirming the feasibility of dosing P-SEP in cord blood of infants with risk factors of EOS to discriminate those who could develop clinical sepsis and spare the inappropriate use of antibiotics.

Biochemical surveillance versus clinical observation of term infants born after prolonged rupture of membranes - A quality assurance initiative.

To examine whether biochemical surveillance vs clinical observation of term infants with prolonged rupture of membranes as a risk factor for early-onset sepsis is associated with differences in patient trajectories in maternity and neonatal intensive care units. A retrospective study of live-born infants with gestational age ≥ 37 + 0 weeks born after prolonged rupture of membranes (≥24h) in four Norwegian hospitals 2017-2019. Two hospitals used biochemical surveillance, and two used predominantly clinical observation to identify early-onset sepsis cases. The biochemical surveillance hospitals had more C-reactive protein measurements (p < 0.001), neonatal intensive care unit admissions (p < 0.001) and antibiotic treatment (p < 0.001). Hospitals using predominantly clinical observation initiated antibiotic treatment earlier in infants with suspected early-onset sepsis (p=0.04) but not in infants fulfilling early-onset sepsis diagnostic criteria (p=0.09). There was no difference in antibiotic treatment duration (p=0.59), fraction of infants fulfilling early-onset sepsis diagnostic criteria (p=0.49) or length of hospitalisation (p=0.30), and no early-onset sepsis-related adverse outcomes. The biochemical surveillance hospitals had more C-reactive protein measurements, but there was no difference in antibiotic treatment duration, early-onset sepsis cases, length of hospitalisation or adverse outcomes. Personnel resources needed for clinical surveillance should be weighed against the limitation of potentially painful procedures.

Utility of Umbilical Cord Blood Culture in the Diagnosis of Early Onset Sepsis: A Cross-sectional Study

Introduction: Umbilical cord is the first source of blood from the neonate. The clinical signs associated with sepsis are frequently non specific and subtle in the neonates making the diagnosis of infection difficult. Umbilical cord blood does not involve pain infliction, avoids iatrogenic blood loss and procedural complications. Aim: To evaluate the utility of Umbilical Cord Blood Culture (UCBC) in the diagnosis of Early Onset Sepsis (EOS). Materials and Methods: The present study was a crosssectional study carried out in neonatology unit of Department of Paediatrics, Rural Medical College, Loni, Maharashtra, India, for the period of mid-March 2021 to mid-September 2021. Neonates delivered in Rural Medical College to the mothers having the risk factors for EOS were included in this study. Informed consent was taken prior to start of study. Thus, 68 samples were collected and studied. UCBC was collected with all aseptic precautions immediately after the umbilical cord was cut after the birth of the baby, venous blood sample was collected within one hour of birth. The data was presented as count and percentages. Results: Majority were female neonates 40 (58.8%). On analysing maternal risk factors it was seen 8.8% had previous low birth weight and 13.2% had Rh negative status. Analysis for presence of risk factors for sepsis majority 79.4% were multiple times examined per vaginally, followed by 36.8% had foul smelling liquor, 11.8% had febrile illness and 5.8% had birth asphyxia. On umbilical cord culture and sensitivity, most common microorganism identified was Staphylococcus aureus 8 (11.8%), followed by 8.8% Pseudomonas species. So, present study shows that 35.3% (24 cases) had positive culture reports using utility of UCBC in 68 patients. Conclusion: Study concludes that umbilical cord blood sampling and culture can be used as a tool for diagnosing bacterial sepsis in neonates especially the high-risk neonates.

Early Antibiotic Exposure and Adverse Outcomes in Very Preterm Infants at Low Risk of Early-Onset Sepsis: The EPIPAGE-2 Cohort Study

To assess the association between early empirical antibiotics and neonatal adverse outcomes in very preterm infants without risk factors for early-onset sepsis (EOS). This is a secondary analysis of the EPIPAGE-2 study, a prospective national population-based cohort that included all liveborn infants at 22-31 completed weeks of gestation in France in 2011. Infants at high risk of EOS (ie, born after preterm labor or preterm premature rupture of membranes or from a mother who had clinical chorioamnionitis or had received antibiotics during the last 72hours) were excluded. Early antibiotic exposure was defined as antibiotic therapy started at day 0 or day 1 of life, irrespective of the duration and type of antibiotics. We compared treated and untreated patients using inverse probability of treatment weighting based on estimated propensity scores. Among 648 very preterm infants at low risk of EOS, 173 (26.2%) had received early antibiotic treatment. Early antibiotic exposure was not associated with death or late-onset sepsis or necrotizing enterocolitis (OR, 1.04; 95% CI, 0.72-1.50); however, it was associated with higher odds of severe cerebral lesions (OR, 2.71; 95% CI, 1.25-5.86) and moderate-severe bronchopulmonary dysplasia (BPD) (OR, 2.30; 95% CI, 1.21-4.38). Early empirical antibiotic therapy administrated in very preterm infants at low risk of EOS was associated with a higher risk of severe cerebral lesions and moderate-severe BPD.

A clinical analysis of sepsis in very low birth weight infants

OBJECTIVE To study the incidence and clinical features of sepsis in very low birth weight (VLBW) infants. METHODS The clinical data were collected from VLBW infants, with a birth weight of < 1 500 g, who were admitted to the Department of Neonatology, Maternity Hospital Affiliated to Nanjing Medical University, from January 2019 to June 2020. The incidence of sepsis, distribution of pathogenic bacteria, and risk factors for sepsis were analyzed. RESULTS A total of 369 infants were enrolled, and 138 infants had sepsis, among whom 84 had early-onset sepsis (EOS) and 54 had late-onset sepsis (LOS). Enterococcus faecalis (24%) and Streptococcus (21%) were the main pathogenic bacteria in infants with EOS, and Staphylococcus (41%) and Enterobacter (29%) were the main pathogenic bacteria in infants with LOS. The incidence of EOS and LOS decreased with the increase of gestational age and birth weight (P < 0.05). The multivariate logistic regression analysis showed that a high birth weight was a protective factor against EOS (OR=0.996, 95%CI:0.993-0.998, P < 0.05), while vaginal delivery (OR=2.781, 95%CI:1.190-6.500, P < 0.05) was a risk factor for EOS, and long duration of parenteral nutrition was a risk factor for LOS (OR=1.129, 95%CI:1.067-1.194, P < 0.05). CONCLUSIONS Enterococcus faecalis is the most common pathogenic bacteria for EOS, and Staphylococcus is the most common pathogenic bacterium for LOS in VLBW infants. A high birth weight may reduce the risk of EOS in VLBW infants, while vaginal delivery may increase the risk of EOS. Prolonged parenteral nutrition may increase the risk of LOS.

Case 2: Early-Onset Neonatal Sepsis in a Term Neonate

Case 2: Early-Onset Neonatal Sepsis in a Term Neonate

ASSOCIATION OF SERUM PROCALCITONIN LEVEL IN THE UMBILICAL CORD BLOOD OF THE NEONATES BORN WITH PERINATAL RISK FACTORS FOR EARLY-ONSET SEPSIS.

Introduction: Sepsis remains one of the most common causes of neonatal mortality and morbidity in India as also globally. Aim:To evaluate the level of procalcitonin (PCT) in the cord blood of the neonates born with perinatal risk factors for early-onset sepsis (EOS) at a tertiary referral hospital of Kolkata. Materials and methods: st An observational cross-sectional study Labour room of R G Kar Medical College &amp; Hospital, Kolkata From February 1 , st 2019 to July 31 , 2020. Conclusion: This practice would represent a reduction of the potential toxicity in the newborns and in the development of bacterial resistances as well. However, maternal prophylactic antibiotherapy decreases the incidences of vertically transmitted neonatal infections

Influence of premature rupture of membranes on the early prognosis of extremely premature infants

OBJECTIVE To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation. METHODS A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group (n=69) and non-PROM group (n=110). A statistical analysis was performed for maternal data and early prognostic indicators. RESULTS Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) (P < 0.05) and significantly lower rate of use of pulmonary surfactant and incidence rate of hemodynamically significant patent ductus arteriosus (P < 0.05). The multivariate logistic regression analysis showed that chorioamnionitis was an independent risk factor for early-onset sepsis and NEC (OR=11.062 and 9.437 respectively, P < 0.05), and PROM was an independent protective factor against the use of pulmonary surfactant (OR=0.363, P < 0.05). CONCLUSIONS PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.

Epidemiology of Early and Late Onset Neonatal Sepsis in Very Low Birthweight Infants: Data From the German Neonatal Network.

Sepsis is a major cause of death in neonates. Knowledge about epidemiology, risk factors, causative pathogens and outcome of neonatal sepsis is important to improve neonatal care. For Germany, only few data on neonatal sepsis in very low birth weight (VLBW) infants exist. Data from 14,926 preterm infants with birth weight <1500 g and gestational age between 22 0/7 weeks and 31 6/7 collected between January 2009 and December 2017 were analyzed for frequency of early-onset sepsis (EOS) and late-onset sepsis (LOS) and for causative pathogens. Risk factors for the development of EOS and LOS and outcomes after EOS and LOS were analyzed by multivariate logistic regression models. EOS occurred in 1.1% of infants and LOS in 11.9%. Escherichia coli was the most common pathogen in EOS, coagulase-negative staphylococci in LOS. Multidrug-resistant organisms were detected in 8.4% of EOS and 3.9% of LOS cases. Risk factors for EOS were lower gestational age, intra-amniotic infection and spontaneous delivery. Risk factors for LOS were lower gestational age, small for gestational age, central lines, endotracheal ventilation and history of EOS. Both EOS and LOS were independently associated with adverse neonatal outcome. These data from a large German neonatal cohort confirm neonatal sepsis as the most common cause of morbidity and mortality in VLBW infants, as well as E. coli and coagulase-negative staphylococci as the most prevalent pathogens. Multidisciplinary approaches such as antibiotic stewardship, hygiene and feeding strategies are necessary to further reduce the burden of sepsis in VLBW infants.

Suspected or Proven Early-Onset Sepsis and NLR, PLR, and MPV Parameters in Neonates with Born through MSAF.

It was aimed to determine the presence of early-onset sepsis in newborns born through meconium-stained amniotic fluid (MSAF) and to investigate the changes of blood parameters in these neonates. This cross-sectional observational study was performed with neonates born MSAF were divided into two groups as C-reactive protein (CRP) and procalcitonin (PCT) positive and negative group. A total of 3,096 neonates enrolled in this study, and of these 272 with MSAF (8.7%), 76 (27.9%) with neonates were Group I and 196 (72.1%) neonates were Group II. Group I had significantly higher CRP and PCT values and monocyte values significantly lower than Group II, but there were no statistically significant differences between other investigated blood count parameters. There was no association between the platelet, mean platelet volume (MPV), plateletcrit, platelet distribution width, neutrphil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) and sepsis in neonates born MSAF. The following areas under the receiver operating characteristic curve were found, respectively: MPV was 0.49 (0.36-0.55), NLR was 0.54 (0.48-0.60), PLR was 0.53 (0.47-0.59), and MLR was 0.54 (0.48-0.60). MSAF might be a risk factor for early-onset sepsis in neonates. However, MPV, NLR, PLR, and MLR values cannot be helpful for the detection of suspected or proven early-onset neonatal sepsis in born MSAF neonates. · MSAF might be as a risk factor for EOS in neonates.. · CRP and procalcitonin values may help to be determined at EOS in asymtomatic neonates with MSAF.. · MPV, NLR, PLR, andMLR values do not seemto behelpful for the early detection of sepsis inmeconium-stained term neonates..

Ensuring a Locally Tailored Response to Early Onset Sepsis Screening Meets or Exceeds the Performance of Published Approaches.

Evaluation of well-appearing neonates for early-onset sepsis (EOS) remains controversial. Multiple risk stratification approaches are currently used for the evaluation of EOS. Our aim was to quantify and compare frequency of laboratory evaluation and empirical antibiotics between published and local EOS approaches. This retrospective cohort study included 8240 infants born ≥35 + 0/7 weeks' gestation at an institution from October 1, 2014, to March 1, 2018. Excluded from analysis were 156 patients who exhibited either major congenital anomalies or required antibiotics for surgical issues. A total of 1680 patient charts with risk factors for EOS were reviewed for further demographic data, clinical presentation, laboratory results, and probable recommendations from 4 EOS risk assessment approaches. Laboratory evaluation recommendation was 7.1% for Centers for Disease Control and Prevention 2010 guidelines and local 2016 EOS algorithm, 6% for local 2019 EOS algorithm, and 5.9% for Kaiser Permanente neonatal EOS calculator (neonatal EOS calculator). Antibiotic recommendation was 6% for 2010 Centers for Disease Control and Prevention guidelines, 4.3% for neonatal EOS calculator, and 3.3% for local 2016 and 2019 EOS algorithms. Of the 4 approaches reviewed, the local 2019 EOS algorithm and the neonatal EOS calculator were similar in recommending the lowest frequency of laboratory evaluation and the local 2016 and 2019 EOS algorithms had the lowest recommended antibiotic usage in this population.

Are Early-Onset Sepsis Evaluations and Empiric Antibiotics Mandatory for All Neonates Admitted with Respiratory Distress?

The objective of this study was to evaluate the success and safety of an antimicrobial stewardship protocol for neonates admitted with respiratory distress at birth. A retrospective cohort analysis of all infants admitted to the neonatal intensive care unit (NICU) with respiratory distress from January 2013 to February 2018 was conducted. In April 2016, an antimicrobial stewardship protocol was implemented, dividing neonates into two groups: maternal indications for delivery (no infectious risk factors for early-onset sepsis [EOS]) and fetal indications (risk factors present) for delivery. Neonates with risk factors for EOS were started on empiric antibiotics, those who lacked risk factors were observed. Paired sample t-test and descriptive statistics were used to compare the pre- and postprotocol implementation. There were no missed cases of EOS in our study. Management with empiric antibiotics decreased from 95 to 41% of neonates with respiratory distress after initiation of the protocol. Newborns with a lower mean (±standard errors of the mean [SEM]) gestational age were more likely to receive empiric antibiotics (35.1 ± 0.4 [range: 23-42 weeks] vs. 37.7 ± 0.2 weeks [range: 24-42 weeks]; p < 0.05). Similar findings were seen for neonates with lower mean birth weights (2,627 ± 77 [range: 390-5,440 g] vs. 3,078 ± 51 g [range: 620-6,260 g]; p < 0.05). The antibiotic stewardship protocol safely reduces the administration of empiric antibiotics to symptomatic neonates without missing any cases of sepsis. · Newborns born with respiratory distress often receive broad-spectrum antibiotics upon NICU admission.. · An antibiotic stewardship program was created for this population and considered perinatal risk factors for sepsis when determining whether antibiotics were indicated.. · This antibiotic stewardship program was safe and effective, significantly reducing antibiotic use without missing any cases of sepsis..

Not all newborns born to mothers with clinical chorioamnionitis need to be treated

Purpose The 2010 recommendations of the Centers for Disease Control and Prevention (CDC) for prevention of perinatal group B Streptococcal Disease (GBS) is that symptomatic newborns suspect for early onset sepsis (EOS), or newborns born to mothers with clinical chorioamnionitis should receive antibiotic treatment. Our protocol was changed accordingly during 2015. We prospectively assessed the safety of the protocol and evaluated the need to treat all newborns born to mothers with clinical chorioamnionitis and retrospectively evaluated the performance of the EOS risk calculator. Methods The study period was from May 2015 to April 2016 at the Kaplan Medical Center (KMC). Inclusion criteria were: gestational age of 35 weeks and above, newborns that were treated with antibiotic, newborn born to mothers with risk factors for EOS or with maternal clinical chorioamnionitis, or to mothers that were given intra-partum antibiotic prophylaxis (IAP). Results In the study period, 7058 newborns were born, 1341 (19%) neonates were included according to the inclusion criteria. Six newborns had EOS (0.85 per 1000 live born). 123/1341 (9%) of the neonates were symptomatic of whom six (4.9%) had proven EOS with RR 10.9 (CI 3.5–33.39, p < .0001), NNT was 22.6. Of them, 89/1341 (6.6%) were treated for maternal clinical chorioamnionitis, two (2.25%) had proven EOS, but they were also symptomatic. The RR was 5.03 (CI 1.03–24.6 p = .045) and the NNT was 55.5. Symptomatic newborns were at an increased risk of 2.2 to have EOS compared with newborns with maternal clinical chorioamnionitis. During the study period, 201 (15%) newborns received antibiotic treatment, while if we had only used the calculator, 111 (8%) newborns would have been treated (p<.001). Only one (out of three with maternal risk factors) newborn was symptomatic during the first hour of life. Three of the mothers whose newborn developed EOS, had no risk factors so there was no need for the calculator. The calculated EOS risk at birth for the other three ranged from 0.37 to 0.67. Conclusions We suggest that asymptomatic newborns born to mothers with clinical chorioamnionitis should not receive antibiotic treatment automatically.

Impact of New Evidence-Based Sepsis Guidelines on Breastfeeding Rates

Purpose: Traditional management of asymptomatic full term neonates with risk factors for early-onset sepsis has potentially negatively affected maternal-infant bonding and breastfeeding success. Beginning in January 2016, the Lenox Hill Hospital NICU adopted new evidence-based early-onset sepsis guidelines for the evaluation of asymptomatic full term neonates. While the length of stay in the NICU was decreased to just hours in some cases, overall antibiotic utilization did not decrease. In June 2017, the guidelines were modified using the Kaiser Permanente Neonatal Early-Onset Sepsis Calculator to further stratify risk of sepsis. Infants …

Clinical profile and outcome of premature neonates with respiratory distress syndrome: An experience from a tertiary care neonatal unit in Delhi

Background: Respiratory distress continues to be a significant cause of admission to the NICU. It also contributes significantly to morbidity and adverse outcome during the clinical course of the disease. Advances in the field of neonatal care like the use of antenatal corticosteroids, CPAP and noninvasive Ventilation, surfactant, gentle mechanical ventilation, a better understanding of the disease process and early enteral nutrition have resulted in improved survival of premature neonates. Methods: This was a prospective observational study done between January 2015 and September 2016 in a tertiary care NICU which included 209 preterm neonates between 26 weeks to 34 weeks of gestation with respiratory distress. The demographic, clinical, treatment profile and outcome were documented till discharge or death. Result: Out of 209, nearly 61% of the admitted neonates received any course of antenatal corticosteroid. About 43% of the infants had one of the antenatal risk factors for early-onset sepsis. Overall survival was 72.7%. CPAP was used as the primary mode of respiratory support in 88% of cases and the incidence of CPAP failure within 7 days was 29.6%. Almost 56% of neonates required surfactant therapy. INSURE method was used for surfactant administration in 80% cases. The failure rate of the INSURE method of surfactant administration was 27.1% and 37.5% at 72 hours and 7 days of life respectively. Sepsis was the commonest complication and accounted for nearly two-thirds of the mortality. The most common morbidity was sepsis (64.6%) followed by hemodynamically significant patent Ductus Arteriosus (25.8%). The culture positivity rate was 9.6% and Klebsiella was the most common organism isolated (45%). Nearly 11.5% of all cases developed any grade of IVH and 5.7% cases had severe IVH (IVH grade 3). About 11.5% of the cases had NEC of any stage and nearly one-third of these cases had NEC stage 2. Retinopathy of prematurity was identified in 6.2% of all cases and nearly 47% of these infants required therapy. Only 7.2% of the cases required oxygen therapy beyond 36 weeks PMA. Conclusion: Nasal continuous positive airway pressure is a safe and effective mode of respiratory support in preterm neonates with respiratory distress with a failure rate of around 30%. Nearly one-third of neonates who receive INSURE method of surfactant administration may subsequently require mechanical ventilation.

The Utility of Soluble CD14 Subtype in Early Diagnosis of Culture-Proven Early-Onset Neonatal Sepsis and Prediction of Outcome.

This study aimed to evaluate soluble cluster of differentiation 14 subtype (sCD14-ST), also named presepsin, as an early marker for the diagnosis of culture-proven early-onset sepsis (EOS) in neonates and to assess its relation to disease severity and mortality. Out of 60 neonates with risk factors of EOS, 31 neonates were diagnosed as having culture-proven EOS. They were compared with 20 nonseptic controls. We obtained blood samples on day 1 of life for sCD14-ST measurement and sepsis screening. Blood samples were repeated on day 3 in EOS neonates. sCD14-ST was significantly higher in EOS neonates than controls (p < 0.001). Neonates who later developed septic shock had significantly higher day 1 sCD14-ST level than those who did not (p < 0.001). Furthermore, neonates who died had significantly higher day 1 sCD14-ST than survivors (p < 0.001). On day 3, there was a significant decline in sCD14-ST levels than initial levels among survivors. There was a significant positive correlation between day 1 sCD14-ST level and Tollner's sepsis severity score. sCD14-ST could be used as a powerful diagnostic and prognostic marker of EOS. Its quantitative measurement at birth could be a good predictor of sepsis severity and mortality.

Neonatal sepsis: Highlighting the principles of diagnosis and management

Neonatal sepsis is a clinical syndrome consisting of nonspecific symptoms and signs of infection, accompanied by a bacteraemia in the first 28 days of life. The risk of neonatal sepsis and death increases with decreasing birth weight and gestational age. South African data have reported the overall incidence of neonatal sepsis to be 8.5 - 10%, with late-onset sepsis accounting for most of these infections. The diagnosis of neonatal sepsis is not always straightforward, and the initiation and continuation of antimicrobials in these situations relies on good clinical judgment. The need for empirical antimicrobials is driven by the existence of risk factors for early-onset sepsis and clinical symptoms and signs of late-onset sepsis. Antimicrobial stewardship programmes should be in place to guide clinicians to either stop, change, or continue antimicrobials. Institution-specific knowledge of the most common pathogens and the antimicrobial susceptibility pattern is important to prevent the emergence of further antimicrobial resistance.

Cord blood interleukin-6 as a predictor of early-onset sepsis in preterm babies

Background Despite extensive investigation, no single test meets the criteria that could make it an ideal marker for early diagnosis of sepsis in the newborn. Generally, screening includes a complete blood count with differential white blood cell count and may be accompanied by other adjuvant tests such as evaluation of C-reactive protein. Objective The aim of the study was to evaluate the role of cord blood interleukin-6 (IL-6) as an early predictor of early-onset neonatal sepsis in preterm babies. Patients and methods We studied 75 preterm babies with risk factors of early-onset sepsis in Benha University Hospitals and measured IL-6 in cord blood samples to correlate them with C-reactive protein, hemoglobin percentage, white blood cells count with immature/total (I/T) ratio, and platelet count. Patients were classified into three groups according to gestational age and subdivided according to sepsis state into proven sepsis group (12 cases), probable sepsis group (48 cases) and noninfected group (15 cases). Samples were taken from the patients early just after birth in the resuscitation room. Statistical analysis The collected data were coded, tabulated and statistically analysed using SPSS (Statistical Package for Social Sciences), version 18.0. Results were considered significant if P value is less than 0.05 and highly significant if P value is less than 0.01. Results In our study, cord blood IL-6 was significantly higher in the septic group (probable and proven) with median 371.92 and 124.85 pg/ml, respectively, than in the noninfected group, with median 8.53 pg/ml ( P < 0.0001). The best cutoff level for IL-6 to diagnose neonatal sepsis is 47.5 pg/ml, with sensitivity 98.3% and specificity 93.3%. Conclusion Cord blood IL-6 can be used as a predictor of early-onset neonatal sepsis in preterm babies.

Gut colonization by aerobic microorganisms is associated with route and type of nutrition in premature neonates

We hypothesized that the beneficial effects of early enteral compared with parenteral feeding are related to the increased variety of aerobic microorganisms that colonize the gut. Our aim was to describe the relationship, first, between the type of feeding and mucosal colonization and, second, between the type of feeding and the development of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm neonates. In total, 159 neonates aged 72 hours or less with risk factors for early-onset sepsis were recruited to a prospective 2-center study. Rectal swabs were collected on admission and twice per week thereafter. The feeding regimen was recorded for the first 7 days and categorized into total parenteral nutrition (TPN) and 2 regimens of enteral nutrition, that is, breast milk containing regimen (BMCR), for which breast milk constituted at least 11% of the enteral diet, or formula. Herein, 70 neonates received formula, 48 received BMCR, and 41 received TPN; 69 cases of LOS and 15 cases of NEC were observed in 50 neonates. A multiple logistic regression analysis indicated that formula and BMCR were associated with 4- to 5-fold increases in colonization by Gram-negative bacteria (odds ratio [OR], 4.52; 1.87-10.95, and OR, 4.95; 1.90-12.87, respectively) and 5 to 9 times higher odds of colonization by Gram-positive microorganisms (OR, 5.75; 1.89-16.72, and OR, 8.61; 2.52-29.36, respectively) compared with TPN. The only difference between BMCR and the other feeding groups was the higher colonization with Staphylococcus haemolyticus in the latter (formula—OR, 6.24; 1.73-22.50; TPN—OR, 2.75; 1.08-6.97). Compared with BMCR, TPN was associated with an increased odds of LOS (OR, 3.04; 1.02-9.07) and an increased odds of death (19.75; 3.64-107.12) compared with formula. Although early enteral feeding is associated with a higher odds of colonization with opportunistic microorganisms, it should be preferred over TPN whenever feasible, due to the favorable effect on the prevention of LOS.