Clinical and Biomarker Predictors of Neonatal Sepsis - An Observational Study in a Tertiary Care Centre
Abstract
Objectives: Assessing the early clinical features for the early diagnosis of neonatal sepsis in a tertiary care centre from central India.Method: This is an observational, cross-sectional study done between December 2019 and June 2021. Neonates from a tertiary care centre of central India with clinical features of probable sepsis were included in the study. Clinical and laboratory data were collected and analysed. Association was sought between various clinical features and complications with culture-proven neonatal sepsis.
Results: Sixty-five neonates were included, of which 44 (67.7%) were preterm and 21 (32.3%) were full-term. The most common presenting features of early as well as late-onset sepsis were respiratory distress, lethargy, and refusal to feed. Majority of neonates had EOS (60, 92.3%) compared to LOS (19, 29.2%). 14 neonates who were initially treated for EOS were readmitted as LOS. Out of the total 79 blood culture samples sent, only 29 (36.7%) were positive. In both EOS and LOS, Klebsiella pneumoniae (10, 34.5%) was found to be the most commonly isolated organism. Next in frequency were MRSA (6, 20.7%) and Streptococcus pyogenes (3, 10.3%). Respiratory failure (47, 72.3%) was the most common complication, followed by persistent hyperbilirubinemia (42, 64.6%) and hypoperfusion (14, 21.5%).
Conclusions: High suspicion should be kept for neonatal sepsis especially when neonates present with features like respiratory distress, refusal to feed, lethargy, weak/ high pitched cry, thermal imbalance, irritability etc. These features can be implemented at the primary health care level to start early treatment and make quick referrals.
How to cite this article:
Dubey A, Kale PV. Clinical and Biomarker Predictors of Neonatal Sepsis - An Observational Study in a Tertiary Care Centre. Postgrad J Pediatr Adol Med. 2022;1(1):16-20.
References
Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017 Oct 14;390(10104):1770-80. [PubMed] [Google Scholar]
World Health Organization. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. Geneva: World Health Organization; 2020. [Google Scholar]
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018 Mar;6(3):223-30. [PubMed] [Google Scholar]
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), India, 2019-21. Ministry of Health & Family Welfare, Government of India; 2021.
Hornik CP, Fort P, Clark RH, Watt K, Benjamin Jr DK, Smith PB, Manzoni P, Jacqz-Aigrain E, Kaguelidou F, Cohen-Wolkowiez M. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev. 2012 May;88 Suppl 2(Suppl 2):S69-74. [PubMed] [Google Scholar]
Al-Zahrani AK, Ghonaim MM, Hussein YM, Eed EM, Khalifa AS, Dorgham LS. Evaluation of recent methods versus conventional methods for diagnosis of early onset neonatal sepsis. J Infect Dev Ctries. 2015 Mar 15;9(4):388-93. [PubMed] [Google Scholar]
Verma P, Berwal PK, Nagaraj N, Swami S, Jivaji P, Narayan S. Neonatal sepsis: epidemiology, clinical spectrum, recent antimicrobial agents and their antibiotic susceptibility pattern. Int J Contemp Pediatr. 2015;2(3):176-80. [Google Scholar]
Pokhrel B, Koirala T, Shah G, Joshi S, Baral P. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal. BMC Pediatr. 2018 Jun 27;18(1):208. [PubMed] [Google Scholar]
Aletayeb SM, Khosravi AD, Dehdashtian M, Kompani F, Mortazavi SM, Aramesh MR. Identification of bacterial agents and antimicrobial susceptibility of neonatal sepsis. Afr J Microbiol Res. 2011;5(5):528-31.
Giannoni E, Agyeman PK, Stocker M, Posfay-Barbe KM, Heininger U, Spycher BD, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Donas A, Leone A, Hasters P, Relly C, Riedel T, Kuehni C, Aebi C, Berger C, Schlapbach LJ; Swiss Pediatric Sepsis Study. Neonatal sepsis of early onset, and hospital-acquired and community acquired late onset: a prospective population-based cohort study. J Pediatr. 2018 Oct;201:106-14. [PubMed] [Google Scholar]
Jatsho J, Nishizawa Y, Pelzom D, Sharma R. Clinical and bacteriological profile of neonatal sepsis: a prospective hospital-based study. Int J Pediatr. 2020 Aug 26;2020:1835945. [PubMed] [Google Scholar]
Dedeke I, Arowosegbe A, Shittu O, Ojo D, Akingbade O. Neonatal sepsis in a Nigerian tertiary hospital: clinical features, clinical outcome, aetiology and antibiotic susceptibility pattern. South Afr J Infect Dis. 2017;32(4):127-31. [Google Scholar]
Chaudhari K, Shah B, Gosai D. Study of etiology, risk factors, clinical features and outcome in blood culture proven late onset septicemia. Int J Sci Res. 2016;4(12):119-21.
Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21-47. [PubMed] [Google Scholar]
Leante-Castellanos JL, Lloreda-GarcÃa JM, GarcÃa-González A, Llopis-Baño C, Fuentes-Gutiérrez C, Alonso-Gallego JÃ, MartÃnez-Gimeno A. Central-peripheral temperature gradient: an early diagnostic sign of late onset neonatal sepsis in very low birth weight infants. J Perinat Med. 2012 Apr 22;40(5):571-6. [PubMed] [Google Scholar]
Rotaru LT, Ruxanda A, Tica OS, Tudorache S, Boeriu C. Prematurity and sepsis - features and approach difficulties during neonatal emergency transfer. Curr Health Sci J. 2016 Oct-Dec;42(4):347-55. [PubMed] [Google Scholar]
Towers CV, Yates A, Zite N, Smith C, Chernicky L, Howard B. Incidence of fever in labor and risk of neonatal sepsis. Am J Obstet Gynecol. 2017 Jun;216(6):596. [PubMed] [Google Scholar]
Goswami S, Gupta R, Ramji S. Sepsis screen: a useful parameter in early diagnosis of neonatal sepsis in preterm neonates. Int J Lab Hematol. 2020 Dec;42(6):e283-6. [PubMed] [Google Scholar]
Al-Shamahy HA, Sabrah AA, Al-Robasi AB, Naser SM. Types of bacteria associated with neonatal sepsis in Al-Thawra University Hospital, Sana’a, Yemen, and their antimicrobial profile. Sultan Qaboos Univ Med J. 2012;12(1):48-54. [PubMed] [Google Scholar]
Dalal P, Gathwala G, Gupta M, Singh J. Bacteriological profile and antimicrobial sensitivity pattern in neonatal sepsis: a study from North India. Int J Res Med Sci. 2017;5(4):1541-5. [Google Scholar]
Waters D, Jawad I, Ahmad A, Lukšić I, Nair H, Zgaga L, Theodoratou E, Rudan I, Zaidi AK, Campbell H. Aetiology of community-acquired neonatal sepsis in low- and middle-income countries. J Glob Health. 2011 Dec;1(2):154-70. [PubMed] [Google Scholar]
