Comparision of Clinical and Laboratory Parameters in Culture Proven and Unproven Early Onset Sepsis in NICU

Abstract

Backgroud Early onset sepsis remains a major cause for neonatal morbidity and mortality.Objectives The aim of this study was to describe and compare the clinical and laboratory characteristics of neonates in neonatal intensive care unit with culture positive and negative early onset sepsis and verify if there were any differences between the groups.Methods A one year comparative prospective study was conducted from January 2011 to January 2012 in neonatal intensive care unit (NICU), Dhulikhel Hospital, Kathmandu University Hospital (KUH).Results Out of 215 cases of suspected neonatal sepsis, 192 (89.30%) cases of early onset sepsis were admitted in neonatal intensive care unit. Out of which 82 cases (42.7%) had blood culture positive and 110( 57.3%) had culture negative but compatible with features of clinical sepsis. There were no cases of culture proven meningitis and urinary tract infections.The clinical characteristic did not show any statistical differences between the study groups except for seizure which was found to be high in culture positive cases (p= 0.041). The hospital stay in neonatal intensive care unit was significantly longer (p=0.02) in culture positive cases. As for the laboratory test there were no differences found between the two study groups except cases of meningitis was more in culture proven early onset sepsis (p=0.00). The overall mortality in early onset sepsis was 36.95%. The higher mortality of 64.7% was seen in culture positive cases but statistically not significant.Conclusion Clinical manifestation and laboratory test were insufficient to distinguish between neonatal infection with blood culture positive and negative sepsis, hence both culture positive and negative cases should be treated promptly and equally.Kathmandu Univ Med J 2013; 11(4): 310-314

The Profile of Neonatal Sepsis in Duhok City and Predictors of Mortality: A Prospective Case Series Study

“…Male gender is a predictor of mortality in this study, which suggests the probability of sex related factors in host susceptibility. Similar results were found by other studies 17,27 while others did not find any role of sex in predilection to mortality 15,21,23 . Mostly, because of inherent immunodeficiency in premature neonates and the need for prolonged hospitalization in low birth weight neonates, sepsis was more common and mortality was higher in these two groups of neonates in our study.…”

“…with similar mortality rates, while the highest rate of mortality was found with Acinatobacter baumannii followed by Staphylococcus aureus. This is similar to another study 30 but in contrast to an Iraqi study 19 where the mortality rates were P. aeruginosa (100%), Staphylococcus aureus (100%) followed by klebsiella (71.1%) and E. coli (48.5%) and other different studies showed similar results 15,[20][21][22][23]26,32 .The hematological variables including hemoglobin, white blood cells, absolute neutrophil count and platelets were found lower in septic neonates who died as compared to those who survived but this difference was not significant. These were found significantly lower in those who died in other studies 12,19,23,33,34 since the toxins produced by the causative bacteria suppress the bone marrow hematopoietic process.…”

“…Mostly, because of inherent immunodeficiency in premature neonates and the need for prolonged hospitalization in low birth weight neonates, sepsis was more common and mortality was higher in these two groups of neonates in our study. This is similar to what was found in other studies in different parts of the world 15,17,22,23,[27][28][29] , but different from other studies 21,31 that found them not significant. Neonates who had, in addition to sepsis, other acute illnesses like respiratory distress and hypoxic ischemic encephalopathy did show a significantly higher mortality in agreement with what was found in other studies 17,23 because they need prolonged hospital stay and may be subjected to more invasive procedures.…”

“…Mortality from neonatal sepsis in this study was 25.39%, which is close to the results of other studies where it was in United Arab Emirates (26%) 15 , in USA 16 , and Saudi Arabia it was 28% 17 . It is higher than what was found in Nigeria, where it was 19.3% 18 but the mortality is lower than two Iraqi studies where they were(44.2%) 19 and (43.5%) 20 ,a study in Nepal(36.95%) 21 a Saudi study (44%) 22 and Mexican study (43.9%) 23 . Many factors explain the difference in mortality rate among different countries like use of ventilators, different microorganisms, socioeconomic and racial factors, incubators, use of different antibiotics and geographical factors 15 .…”

Prevalence of Sepsis and Possible Severe Bacterial Infection among Neonates in Nepal

“…However, it is important to note that the prevalence of culture-proven neonatal sepsis among the suspected neonates is very high in Nepal ranging from 15% to as high as more than 50%. [19][20][21][22][23] In a systemic review done to estimate possible severe bacterial infection in neonates in Sub-Saharan Africa, South Asia, and Latin America for 2012, the pooled estimate of PSBI incidence risk was 7.6% (95% CI 6.1-9.2%). 24 Neonatal infections, the single largest cause of neonatal mortality globally, is preventable with existing evidence-based, cost-effective interventions.…”