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Neonatal sepsis and long term outcome
Abstract
Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 4 weeks of life. It is associated with significant mortality and morbidity. Role of infection as an independent risk factor for adverse outcome cannot be easily determined due to associated co-morbid conditions. Sequelae resulting from neonatal sepsis have not been well studied. Maternal infection can result in cerebral palsy by causing preterm birth, overwhelming sepsis in the fetus or newborn or placental insufficiency and birth asphyxia. Periventricular leukomalacia is associated with prolonged rupture of the fetal membranes and chorioamnionitis. Intrauterine infection produces proinflammatory cytokines which disrupt oligodendrocyte development in the preterm fetal brain. Neonatal infections could result in brain damage directly by causing meningitis or as a result of toxin and cytokine mediated systemic inflammatory response. Sepsis is known to be an important cause of retinopathy of prematurity and hearing impairment.
... yang tinggi. 3,4 Insidens sepsis pada neonatus 1 sampai 5 per 1000 kelahiran hidup. Insidens lebih tinggi pada bayi dengan berat badan lahir sangat rendah yaitu 15 sampai 19 per 1000 kelahiran hidup pada sepsis awitan dini dan 21% pada sepsis awitan lambat. 2 Progresivitas gejala dari ringan hingga kematian dapat terjadi kurang dalam 24 jam. ...
Latar belakang. Sepsis neonatus sebagai suatu sindrom klinis yang terjadi dalam satu bulan pertama
kehidupan bermanifestasi sistemik dan dijumpai bakterimia. Insidens sepsis bervariasi dengan gejala klinis
tidak khas dan progresivitas gejala dapat terjadi dalam 24 jam. Sepsis pada neonatus mempunyai tingkat
mortalitas tinggi.
Tujuan. Mengetahui profil dan mortalitas sepsis neonatus di Unit Perawatan Neonatus RSUP.H Adam
Malik Medan
Metode. Suatu penelitian deskriptif data rekam medis pasien sepsis neonatus di unit perawatan neonatas
RSUP. Adam Malik Medan, sejak Januari 2008 sampai Desember 2010. Data pasien dilakukan pemeriksaan
darah lengkap, C-reactive protein (CRP),dan kultur darah, serta antibiotik empiris. Pasien dengan data
tidak lengkap dan menderita kelainan bawaan serius dieksklusi. Sampel dikelompokkan dua kelompok yaitu
bayi pulang hidup dan meninggal.
Hasil. Didapat 239 bayi diduga sepsis, di antaranya 158 terbukti sepsis, 103 dieksklusi (69 kelainan
kongenital dan 34 data tidak lengkap). Pasien yang diikutsertakan 55 bayi yaitu 44 hidup dan 11 meninggal.
Sepsis neonatus pada laki-laki lebih banyak dari perempuan, tetapi perempuan lebih banyak yang meninggal.
Kepekaan kuman yang tinggi terhadap satu atau kedua antibiotik empiris terdapat pada 13 sepsis neonatus.
Terbanyak meninggal sepsis neonatus dengan berat lahir rendah, prematur, kuman yang resisten terhadap
kedua jenis antibiotik empiris, Gram negatif, dan jenis kuman Enterobacter sp.Jenis kuman yang paling
banyak dijumpai adalah Staphylococcus sp.
Kesimpulan. Sepsis salah satu penyebab utama kematian neonatus yang dipengaruhi oleh berat lahir rendah,
prematuritas, resistensi kuman terhadap antibiotik empirik dan jenis kuman. Penyebab sepsis neonatus
terbanyak adalah kuman Gram negatif yang berkontribusi terhadap angka mortalitas
... Neonatal sepsis is defined as clinical syndrome of bacteraemia with systemic signs and symptoms of infection in first month of life. [1][2][3] It is the commonest cause of neonatal mortality and morbidity in developing countries. [1] Neonatal sepsis is a great mimicker giving rise to signs and symptoms compatible with almost every other neonatal problem thus making clinical diagnosis of sepsis very difficult. ...
To examine the potential contribution of epidemiologic research to the identification of perinatal brain damage as a “cause” of developmental disabilities, the authors review definitions and methods used in this field. The current literature provides considerably different estimates of the population prevalence of mental retardation (3–40 per thousand), cerebral palsy (1.2–2.6 per thousand), and learning disabilities (33–65 per thousand). Furthermore, the presumable proportion of disabilities caused in the perinatal period also differs with the population under investigation, age at examination, and exposure and outcome definition. Approximately 8–43% of cerebral palsy and 10–25% of mental retardation may be associated with variables describing perinatal morbidity usually interpreted as indicators of brain damage. The authors discuss the recent literature on the association of developmental disabilities and proxy variables, e.g., abnormal neuroimaging results, so-called asphyxia, abnormal fetal heart rate patterns or thyroxine levels, and severity of illness scores. Exact definitions of exposure and outcome, a proper study design, and agreement of findings from multiple studies are needed before associations between perinatal brain damage and developmental disabilities should be accepted as causal. MRDD Research Reviews 3:13–21, 1997. © 1997 Wiley-Liss, Inc.
50 patients with congenital rubella, born in 1939-43, were reviewed in 1967. Here we report their outcome in 1991. Since 1967, there have been 7 deaths (3 cardiovascular, 3 malignant disease, 1 AIDS). 40 had full clinical assessment. The prevalence of diabetes mellitus is similar to that in 1967: 4 of the 5 reported diabetic then, remain so, and there is 1 new case. 1 subject has malignant melanoma and 3 have died from cancer. Although the incidence of malignant disease is not increased, the death rate is (standardised mortality rate 6.0, 95% CI 1.24-17.57). Longer follow-up will be required to confirm this observation.