Neonatal sepsis is one of the major health problems throughout the world and one of the commonest causes of neonatal mortality. It accounts for 30-50% of the total neonatal deaths in developing countries. 1,2 Overall incidence of sepsis is 1-5/1000 live births and mortality rate of untreated sepsis can be as high as 50%. 3,4 In India incidence of sepsis is 38 per 1000 live births in tertiary care institutes and it contributes to 36% of deaths in ABSTRACT Background: Neonatal sepsis is one of the commonest causes of neonatal mortality and accounts for 30-50% of the total neonatal deaths in developing countries. Diagnosis of neonatal sepsis is still a great challenge since there is no single laboratory test with 100% sensitivity and specificity. Certain maternal and neonatal characteristics are predictive of Early Onset neonatal Sepsis (EOS) (onset < 72 hours of birth). The objective of this study was to evaluate the correlation of neonatal and maternal clinical and haematological manifestations with EOS and to identify the reliable specific parameters for early diagnosis of neonatal sepsis. Methods: This prospective study enrolled 95 newborns with suspected EOS and their mothers. Perinatal history, clinical profile, symptoms and laboratory data of mother and baby were recorded in each case. The neonatal sepsis screen included TLC, peripheral blood smears (PBS), DLC, ANC, I: T ratio, micro-ESR and platelet count. The maternal haematological parameters were TLC and platelet count. These parameters were evaluated based on the standard reference values. A blood culture was the standard indicator for proven sepsis. Results: Out of 95 newborns presenting with EOS, 46(48.4%) had positive blood culture. EOS was seen predominantly in preterm, males, LBW and neonates delivered vaginally. Among the various neonatal haematological parameters toxic granules, raised Micro-ESR, I/T Ratio >0.2, thrombocytopenia remained significant markers for early diagnosis of culture positive EOS (p <.05). Majority of EOS was caused by Gram negative organisms with E.Coli being the commonest. Important adverse perinatal factors associated with EOS were seen in 64.2% mothers. Maternal total leukocyte count was the most important parameter for predicting EOS in their newborns with a sensitivity of 67.2%, specificity of 77.5%, PPV of 80.4% , NPV of 63.2% though not found statistically significant (p =0.065). Conclusions: Risk factors for EOS include both maternal and neonatal factors. It is very essential to diagnose the sepsis in early phase and it is also important to rule out sepsis to prevent irrational use of antibiotics. A high index of suspicion along with simple, cost effective hematological screening parameters is sensitive and satisfactory tools in predicting early onset neonatal sepsis.
A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p < 0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p < 0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.
Background: Rebound hyperbilirubinemia may occur after cessation of phototherapy in new-borns in certain high-risk situations. However, data regarding the phenomenon of bilirubin rebound is lacking from India. Aim was to study the incidence and associated risk factors of post phototherapy rebound hyperbilirubinemia.Methods: The study subjects included all neonates (gestation >34 weeks) admitted to newborn unit who required phototherapy for hyperbilirubinemia. Unit protocol based on American academy of pediatrics (AAP) guidelines were used to start and stop phototherapy. Rebound bilirubin was measured 24±6 hours after stopping phototherapy. Significant bilirubin rebound (SBR) was defined as post phototherapy bilirubin level needing reinstitution of phototherapy. The risk factors associated with significant rebound were studied.Results: Out of total 509 neonates who received phototherapy due to hyperbilirubinemia, 63 (12%) had significant bilirubin rebound requiring reinstitution of phototherapy. There was significant risk for rebound in neonates who had prematurity (p <0.01), ABO (<0.001) and Rh incompatibility (p<0.005) with mother, G6PD deficiency (p < 0.001) and onset of hyperbilirubinemia less than 72 hours of postnatal age (p< 0.001). However, neonates with extravasations of blood, polycythaemia, sepsis, other causes of haemolysis and idiopathic group did not have significant risk of developing rebound.Conclusions: Post phototherapy bilirubin estimation and follow up should be ensured in high-risk neonates.
During the study period there were 2063 live births. Of these 573 (27.8%) were low birth weight (LBW), 277 (13.4%) preterm and 148 (7.1%) small for date (SFD) babies. In all, 263 (12.7%) newborns suffered from one or the other morbidity. Birth asphyxia of varying severity developed in 130 (6.3%) babies [88 LBW and 42 normal birth weight (NBW) (p < 0.001)]. Respiratory distress syndrome was diagnosed in 82 (3.9%) babies, most being due to hyaline membrane diseases (31.7%), which affected 26 (9.4%) of preterm babies. Deep infections were seen in 109 (5.3%) newborns [60 LBW and 49 NBW, (p < 0.001)] and superficial infections were seen in 79 (3.8%) babies [46 LBW and 33 NBW, (p < 0.001)]. Hyperbilirubinemia was detected in 78 (3.8%) babies. In one fifth of the babies, the cause of hyperbilirubinemia remained unidentified even after detailed investigations. Hypothermia was observed in 59 (2.9%) newborns [48 LBW and 11 NBW, (p < 0.001] and congenital malformations were seen in 24 (1.7%) babies. Morbidity was found to be high amongst LBW and preterm babies. The incidence of deep infections and hypothermia was high in our study.
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