Neonatal Sepsis: Past, present and future; a review article

Internet Journal of Medical Update 07/2010; 5(2). DOI: 10.4314/ijmu.v5i2.56163
Source: DOAJ


Sepsis is the most common cause of neonatal mortality. As per National Neonatal Perinatal Database (NNPD) 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live birth. It is 3% among intramural babies and 39.7% among extramural admissions. The early manifestations of neonatal sepsis are vague and ill-defined. Novel approaches in the diagnosis of neonatal sepsis include heart rate analysis on ECG or colorimetric analysis of skin color. Although blood culture is the gold standard for the diagnosis of sepsis, culture reports would be available only after 48-72 hours. In this era of multidrug resistance, it is mandatory to avoid unnecessary use of antibiotics to treat non-infected infants. Thus, rapid diagnostic test(s) that differentiate infected from non-infected infants, particularly in the early newborn period, that include Interleukien-6 (IL-6), neutrophil CD64 index, procalcitonin and nucleated RBC count, have the potential to make a significant impact on neonatal care. The aim of this review is to specify the diagnostic criteria, treatment guidelines and a summary of the newer diagnostic tests of sepsis.

  • Source
    • "Clinical presentation of neonatal sepsis varies and there are no pathognomonic features [4], however some clinical features have been reported to predict sepsis. Kayange et al. in a study which was conducted in Bugando, Tanzania reported inability to breast feed, lethargy, convulsion, chest wall in-drawing, jaundice and umbilical redness to be strongly associated with neonatal sepsis [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Neonatal sepsis contributes significantly to morbidity and mortality among young infants. The aetiological agents as well as their susceptibility to antimicrobial agents are dynamic. This study determined aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis at Muhimbili National Hospital. Methods Three hundred and thirty neonates admitted at the Muhimbili National Hospital neonatal ward between October, 2009 and January, 2010 were recruited. Standardized questionnaires were used to obtain demographic and clinical information. Blood and pus samples were cultured on MacConkey, blood and chocolate agars and bacteria were identified based on characteristic morphology, gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial sensitivity testing was performed for ampicillin, cloxacillin, gentamicin, amikacin, cefuroxime and ceftriaxone on Mueller Hinton agar using the Kirby Bauer diffusion method. Results Culture proven sepsis was noted in 24% (74/330) of the study participants. Isolated bacterial pathogens were predominantly Staphylococcus aureus, Klebsiella spp and Escherichia coli. Klebsiella spp 32.7% (17/52) was the predominant blood culture isolate in neonates aged below seven days while Staphylococcus aureus 54.5% (12/22) was commonest among those aged above seven days. Staphylococcus aureus was the predominant pus swabs isolate for both neonates aged 0–6 days 42.2% (98/232) and 7–28 days 52.3% (34/65). Resistance of blood culture isolates was high to ampicillin 81.1% (60/74) and cloxacillin 78.4% (58/74), moderate to ceftriaxone 14.9% (11/74) and cefuroxime 18.9% (14/74), and low to amikacin 1.3% (1/74). Isolates from swabs had high resistance to ampicillin 89.9% (267/297) and cloxacillin 85.2 (253/297), moderate resistance to ceftriaxone 38.0% (113/297) and cefuroxime 36.0% (107/297), and low resistance to amikacin 4.7% (14/297). Sepsis was higher in neonates with fever and hypothermia (p=0.02), skin pustules (p<0.001), umbilical pus discharge and abdominal wall hyperemia (p=0.04). Presence of skin pustules was an independent predictor of sepsis OR 0.26, 95% CI (0.10-0.66) p=0.004. The overall death rate was 13.9% (46/330), being higher in neonates with sepsis 24.3% (18/74) than those without 10.9% (28/256), p=0.003. Conclusions Staphylococcus aureus was predominant isolate followed by Klebsiella and Escherichia coli. There was high resistance to ampicillin and cloxacillin. Mortality rate due to neonatal sepsis was high in our setting. Routine antimicrobial surveillance should guide the choice of antibiotics for empirical treatment of neonatal sepsis.
    Full-text · Article · Oct 2012 · BMC Public Health

  • No preview · Article · Mar 2011 · The Indian Journal of Pediatrics
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Septicemia in neonates is the commonest cause of mortality. Early recognition and diagnosis of neonatal sepsis remains a challenge because of the variable and nonspecific clinical presentation. The laboratory criteria are often non specific and not fully reliable. The objective of this review is to highlight the various hematological and biological markers of neonatal sepsis. We searched PubMed and Elsevier’s web of science from studies evaluating the hematological and biological markers of neonatal sepsis. The key words used were “neonatal sepsis”, “hematological marker” and ”biomarker”. Since a battery of markers of neonatal sepsis are available, it is always better to rely on a combination of markers along with the clinical correlation. Key words: Neonate, Septicemia, Biological Marker
    Full-text · Article · Jan 2013 · Iranian Journal of Pathology
Show more