Background: Septicemia in neonates refers to bacterial infection documented by positive blood culture in the first four weeks of life and is one of the leading causes of neonatal mortality and morbidity. Objective: To isolate and identify the bacterial etiologic agents responsible for neonatal sepsis and to determine the susceptibility pattern of isolates in A NICU of Dhaka Shishu (Children) Hospital. Methods: This is a prospective observational study conducted in the NICU from July 2018 to December 2018. Two hundred ninty blood samples were collected and processed from patients in accordance with standard protocols. Antibiotic susceptibility of the isolates was done. Results: Blood culture reports were positive in 9.31% cases. Among the culture positive cases, there were 65.5% males and 34.5% females. Early onset sepsis was present in 74.8% and late onset sepsis was observed in 25.2% of the cases. Best overall sensitivity among Gram negative (Acinetobacter, Klebsiella, Pseudomonas) isolates was to netilmycin (61%), followed by ceftazidim (57%) and amikacin (56%).Gram positive (Staphylococci, streptococci) isolates had sensitivity of 50% to levofloxacin, 50% to ceftriaxon. Conclusion: Gram negative organisms are the leading cause of neonatal sepsis in this study and most of them are resistant to multiple antibiotics. Therefore the results of this study suggest that, surveillance of antimicrobial resistance in our hospital is necessary. DS (Child) H J 2019; 35(2) : 130-134

Background : Neonatal sepsis is a common occurrence and major health problem in Bangladesh and other developing countries, a devastating cause of morbidity and mortality during first 28 days of life.Objective: This study was carried out to evaluate the efficacy of hematological scoring system (HSS) in the early detection of neonatal sepsis.Study period : June 2014 to December 2014(Six months).Methods : This was a prospective study consisting of 218 neonates admitted at Intensive Care Unit (ICU) Dhaka Shishu Hospital who were clinically suspected to have septicaemia. Newborn babies with major congenital anomaly,inborn error of metabolism, severely jaundiced due to blood group incompatibilities or RDS (due to surfactant deficiency) were excluded. The hematological parameter were measured in all cases. Patients were scored according to hematological scoring system (HSS), incorporating increase or decrease in leucocytes count, absolute neutrophil count, immature neutrophil count (e.g. band form), presence of degenerative changes in neutrophil (e.g. toxic granulation, vacuolation). CRP estimation and blood culture were also performed. Blood culture is considered as gold standard for diagnosis of sepsis. Fourteen out of 128 (11%) had culture proven sepsis. They were predominantly preterm and of very low birth weight. Score of 3 was considered as positive.Results : On evaluation of various hematological parameters the HSS was found to have a sensitively of 71%, specificity of 73%, positive predictive value 24%, negative predictive value 95%.Conclusion: HSS is a simple, quick, readily available effective tool to detect early neonatal sepsis. Considering the high sensitivity, specificity, negative predictive value, this study implies that score ³3 were reliable as a screening tool for early neonatal sepsis.Northern International Medical College Journal Vol.7(2) Jan 2016: 135-138

Background : Neonatal Intensive Care Unit (NICU) is predominately concerned with the management of critically sick neonates having acute life threatening conditions. Usually neonates having respiratory distress, acute neurological deterioration, severe infection and prematurity contribute the major admission in a NICU.Objective : To find out the disease pattern and biochemical profile as a predictor of outcome of critically sick neonates in NICU.Methods : This observational prospective study was carried out at NICU of Dhaka Shishu (Children) Hospital from January 2015 to July 2015. Total 121 neonates were enrolled according to inclusion criteria and analyzed some important biochemical profile specially electrolyte and blood gas status as a part of proper management as well as to predict their outcome.Results : Among critically sick neonates, perinatal asphyxia was common disorder followed by sepsis. Biochemical profile specially electrolyte and acid-base disruption play important role to the outcome of critically sick neonates. Low pH, low potassium and high base-deficit level were found to have worse outcome. Conclusion :Perinatal asphyxia constitutemajor cause of admission ofcritically sick neonates. Early detection of electrolyte and acid-base status is helpful to care and overall survival of these neonates. Mortality was the highest among neonatal sepsis followedby perinatal asphyxia. Metabolic acidosis and hypokalemia were the predictor of outcome of such critically sick neonates.

Hypocalcemia is common in the critically ill pediatric patients. However, the diagnosis of hypocalcemia in this population is complicated by interpretation of the total plasma calcium concentration. These limitations are principally the result of the effects of hypoalbuminemia and disorders of acid-base balance on the total calcium concentration. Thus, measurement of ionized calcium can be critical in determining an individual’s true serum calcium status. In this review, we first described the regulation of normal calcium metabolism and then focus on the various etiologies of hypocalcemia, which are encountered in the pediatric critical care settings. The approach to the treatment of hypocalcemia and the current consensus on treatment of hypocalcemia in the critically ill pediatric patient is also presented. DS (Child) H J 2019; 35(2) : 156-161

Background : Blood gas abnormalities are frequently encountered in sick neonates admitted in ICU. They contribute significantly to mortality. Therefore, blood gas status is a helpful indicator of the condition of sick neonate.