Question
Asked 28th Dec, 2012

What is/are the earliest predictor(s) of neonatal sepsis ?

Early prediction of sepsis can help better management of patients and better prognosis. Our protocol for treating suspected neonatal sepsis is to start empirical broad spectrum antimicrobials and to send sepsis screen which consists of a battery of tests like total counts, platelets counts, immature neutrophils counts (Band cells), CRP, Micro ESR, and blood culture. If Sepsis Screen results are positive but blood culture negative, we stop antimicrobials after 5 days and if blood culture positive then we change antimicrobials accordingly and complete 14 days.

Most recent answer

30th Dec, 2013
Dr.chandra madhur Sharma
Shri Guru Ram Rai Institute of Medical and Health Sciences
Neonatal Sepsis is an emergency. Earliest clinical features includes refusal to feed, feed intolerance, hypothermia, excessive cry or lethargy, respiratory distress and increased CFT. In case of maternal risk factors such as foul smelling liquor, maternal fever, chorioamnitis we should treat them as probable sepsis and start empirical antibiotics as early as possible. Lab findings includes sepsis screen and blood culture. Lab findings are adjunct to clinical diagnosis.
2 Recommendations

All Answers (19)

28th Dec, 2012
Erol Erduran
Karadeniz Technical University
In my opinion, the early predictive findings of sepsis are thrombocytopenia, increased D- dimer, increased serum insuline level and high serum IL-6 and CRP levels in addition to clinical findings related to septicemia such as agonia, hypotension, cutis marmaratus, peripheral collapse. Which one is more important for early diagnosis of sepsis? I don't know. But, I can speculate that thrombocyopenia, increased D-dimer and serum insulin level are more important than others for early diagnosis of sepsis.
1 Recommendation
28th Dec, 2012
Joachim Pimiskern
There is a PCR test. It is not mentioned which pathogens
are searched.
An Austrian company developed a protein chip
(sorry, no English text available).
Adam Linder identified HBP (heparin-binding protein) as
sepsis biomarker.
Another gene expression biomarker test is
Regards,
Joachim
28th Dec, 2012
Erol Erduran
Karadeniz Technical University
Sepsis is an urgent disease. Gene studies and long-lasting protein analysis is a waste of time. İt is not pratical to study above mentioned laboratory tests such as PCR analysis, heparin-binding protein and gene expressions. Clinicians have to give right, acute and the best desicion for patient. This is especially true for sepsis.
2 Recommendations
28th Dec, 2012
Sven Van Poucke
Ziekenhuis Oost Limburg
The clinical picture related to the hospital admission, although difficult to quantify.
28th Dec, 2012
Andrew E Williams
University College London
There are no specific biomarkers that can specifically diagnose sepsis. The most commonly used markers are serum CRP and PCT levels, although these are not specific for sepsis as that can also be elevated in other inflammatory conditions and even trauma. The same holds true for cytokines such as TNF and IL-6. Bacterial culture has also been used but this relies on being able to culture the bacteria. In reality, a combination of predictive tests are probably needed but this has not been thoroughly tested.
Back to the clinicians best decision...
2 Recommendations
29th Dec, 2012
Ru-Jeng Teng
Medical College of Wisconsin
The question should be asked more specifically. The age group will also determine the appropriate answer. In premature infants a recent tool in the HERO monitor which analyze the variation of heart rate continuously and provide a prediction. Hemogram and classification is the routine for pediatricians but the sensitivity and specificity are very poor (~25-30% depend on the threshold). Any so called the good indicator (IL-8 nephelometry, cytokine array, PCR) are either way too sensitive or too expensive and provide too many false alarms (detect the gene not necessary mean the patient is really septic). I have some colleague insist using CRP and ended up keeping a lot of healthy newborn babies in the nursery on antibiotics for two weeks (to the best of my knowledge none of the 20 treated babies had any positive culture). Some papers use 10-25 parameters to build an algorism to predict sepsis but they all become so hard to use so nobody really using them. To me a clinical judgement may be more important and everybody can do it. Treat when you suspect it then taper down if the culture come back negative in 48 hours maybe more useful to clinicians.
29th Dec, 2012
Reza Nemati
Auckland University of Technology
Hi
In my opinion the frist step to detect sepsis as this disease is an urgent case to initiate treatment, is drawing the blood sample and observe a slide with Gram stain.
if the rate of infection would be high then it can simply indicate either gram negative or gram positive bacteria. However in some conditions such as fastidious blood-born infection this situation will be different.
when you suspect to sepsis, measuring of some laboratory tests may be helpful which are not time-consuming such as CRP, ESR and CBC also you can check random blood sugar and plasma protein which can be decreased during septicemia. It is recommended during the suspicious case antibiotic therapy must be started.
Most of clinically significant blood born bacteria can be detected during 6-12 hours of sample collection by acridine orange stain, you can also consider it.
some companies produce commercially kits for rapid diagnosis of bacteraemia such as BACTEC and something like that.
I hope my statement can be useful
Best regards
29th Dec, 2012
Lennart Bongartz
University Medical Center Utrecht
Early predictors of sepsis are the SIRS criteria:
1. tachypnea
2. tachycardia
3. fever or hypothermia
4. evidence of decreased organ perfusion: oliguria/anuria, altered mental status (drowsiness, agitation, delirium, seizures)
These are also valid in pediatric patients and should alert you to impending septic shock. Assessing for skin color changes, petechiae etc may be helpful.
Blood analysis may show high leukocyte count and/or high levels of CRP, and taking blood cultures at first presentation is justified. Starting with empirical AB therapy is a good first step.
I also believe that the gram stain, which can be performed very quickly, is the most helpful and easy first step to do to assess for bacteremia. Results of subsequent cultures may then guide further AB choice, as well as the identified source of the sepsis. Repeat blood cultures if no response to AB, and consider further analysis for atypical micro-organisms or viruses. With suspected pneumonia, urine antigen testing for pneumococcal disease or legionella may be helpful.
Hope this helps!
2 Recommendations
29th Dec, 2012
Erol Erduran
Karadeniz Technical University
It is unforgotten that clinical findings of sepsis in newborn such as hypotonia, tachypnea, hypoactivity, weak or no sucking, hypothermia, cutis marmaratus, convulsion are more important than laboratory findings. Although definitive diagnosis of sepsis is the growth of any microorganism in blood culture medium, it is time consuming. To start of the treatment of sepsis is urgent and treatment should be started as soon as possible when sepsis is suspected. Laboratory findings help the diagnosis of sepsis and these are valuable if laboratory findings support the diagnosis, as always.
1 Recommendation
3rd Jan, 2013
Shakila Srikumar
try procalcitonin estimation
10th Jan, 2013
Omar Daoudi
Lunginnov
Try Endocan/ESM-1 ELISA Kit
19th Jan, 2013
Herbert Anayo Obu
University of Nigeria
Neonatal sepsis is life threatening and needs to be handled rather urgently. I high index of suspicion is necessary for early diagnosis and treatment. Clinical features such as poor feeding, excessive crying and fever should arouse the suspicion of sepsis in the newborn and warrant prompt diagnostic work up, including a pan-culture, complete blood counts with ESR, platelet counts, total white cell counts and I/T ratios.
1 Recommendation
19th Jan, 2013
Erol Erduran
Karadeniz Technical University
Fever is everytime a diagnostic marker of neonatal sepsis because sometimes, hypothermi occurs in neonatal sepsis. Clinical findings are more important than laboratory findings of neonatal sepsis. Laboratory findings are important if they support to the clinical findings of neonatal sepsis. The most important and pratical laboratory findings are peripheral blood smear including vakuolization of neutrophils, toxic granulation, Dohle body, immatur/total neutrophils> 0.2, thrombocytopenia associated with increased D-dimer.
1 Recommendation
8th Mar, 2013
Amir mohammad Armanian
Isfahan University of Medical Sciences
In the name of Allah
If any of these is not OK. possibility of neonatal sepsis rises:
Level of Activity
Pattern of Feeding
Muscle Tone
Level of Alertness
Respiratory status or effort (Breathing)
Peripheral Perfusion.
The negative predictive value (NPV) of this scoring system was 96%.
5th May, 2013
Muhammad Javed
chinot general hospital
We consider sepsis in neonate in lethargic child with reluctant to feed and temperature and cvs in stability
4th Jun, 2013
Philippe Poncelet
Stago
Bruce Davis proposes CD64 expression by quantitative FCM, including most recently with CBC instruments. Follow his name in ResearchGate, LinkedIn or Pubmed. Home that helps. PP
19th Nov, 2013
Indrajit Suresh
Columbia Asia Hospital - Mysore
Each physician has his/her own set of indicators. I use a few which are based on clinical findings/history and investigations.
Mine would be
1) History of reduced activity/ dull or irritable child
2) Reduced appetite
3) weight loss
4) Cold, clammy extremities
5) Weak pulse
Among the investigations (Quickly available)
1) CBC - In this - elevated total counts and an early reactive thrombocytosis followed by a dropping platelet count
2) CRP
I have not mentioned the entire panel because these are the 'earliest' and reasonably accurate (taken together) ones I have found in my experience. These investigations would also be cheaper.
5th Dec, 2013
Olusegun Joseph Adebami
Ladoke Akintola University of Technology
Golden rule in the diagnosis of NNS is high index of suspicion of NNS or when NNS is likely. It could be based on presence of maternal, fetal/neonatal or environmental risk factors including possibility of sepsis in the internal milieu or the inner house where the baby is coming from. Presence of any symptom especially reduced activity, reduced sucking, abdominal distension and respiratory distress makes the diagnosis more likely. Laboratory findings are adjunct in the diagnosis. Because of wide range of normality in the laboratory investigative values, many of the laboratory findings are non-specific. Many times, intervention may be coming too late if the diagnosis is based on CVS instability or an organ dysfunction. It is also important to know that because of fear of infection, unusual predisposition to infection in newborn period, progression and severity an infection may attain in newborn period, unnecessary use of antibiotics in the newborn is common especially in the developing countries where infection is commoner and screening facilities are limited. Therefore, to treat or not to treat a baby with suspected infection will be based on clinical status, close monitoring and follow up.

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