Evaluation of screening of neonatal sepsis

Abstract

Background: Neonatal sepsis is an important cause of neonatal mortality and morbidity. Early diagnosis of sepsis is difficult due to its non- specific clinical presentation. The gold standard for diagnosis is blood culture, which is obtained in only 25%-40% of cases and requires 48-72 hours. There is a need for a sepsis screen for early diagnosis of septicemia and identification of culture negative cases. The objective of the study was to study the role of sepsis for early diagnosis of septicaemia and identification of culture negative cases and to compare the rapid diagnostic tests with blood culture singly and in combinations for specificity and sensitivity.Methods: 60 cases of suspected septicemia were studied. Total leucocyte count, bandforms peripheral smear examination, C-reactive protein assay, micro-ESR, and blood culture study was investigated. Results: Study revealed that CRP had maximum sensitivity while band neutrophil ratio had balanced sensitivity and specificity. In the two tests, CRP with PS/BF had balanced sensitivity and specificity. In the three tests combination, CRP with TC with micro-ESR had balanced sensitivity and specificity in proven sepsis, While CRP with BF with micro-ESR had balanced sensitivity and specificity in most probable sepsis cases.Conclusions: Neonatal sepsis has vague signs and symptoms, so high index of suspicion helps in arriving early diagnosis and management. CRP had maximum sensitivity in the individual tests. Using either two tests (CRP + PS/BF) or three tests (CRP + Micro ESR + BF/TC) most of the sepsis cases could be identified and sepsis negative cases can be ruled out. Sepsis screen is helpful in avoiding overuse of antibiotics.

Risk factors of neonatal sepsis in India: A systematic review and meta-analysis

“…laboratory setups) in resource-limited settings. [5, 13] Variations in definitions have direct implications on research, and clinical practice, and reflect on achieving the overall aim of reducing burden of sepsis in neonates. [10, 11, 61] While reaching a consensus is not in any way an easy task,[11] we encourage authors of primary studies to report guidelines which have influenced their case definitions for transparency and clarity, thus improving comparability.…”

“…[3] The case fatality rate of sepsis among neonates ranges between 25% to 65% in India. [4, 5] These rates are likely to be underestimated, and more accurate data is expected from the ‘Global Maternal and Neonatal Sepsis Initiative’. [6–8]…”

“…[10–13] Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis (EOS). [14] Culture results take up to 48 hours; have been found to be positive in 25% to 45% of cases;[5] and run the risk of false-positive/ low-yield results after antenatal antibiotic exposure. [15] Moreover, culture-testing facilities are absent from most district hospitals in India.…”

“…[15] Moreover, culture-testing facilities are absent from most district hospitals in India. [5] In this scenario, the prediction and diagnosis of neonatal sepsis relies on culture-independent diagnostics and risk factor-based scoring systems. [16]…”

Bacteriological Profile of Clinically Suspected Septicemia Among Neonates and the Antibiotic Susceptibility Pattern of Their Isolates: A Cross-Sectional Study in a Tertiary Care Hospital of Jharkhand

“…In India, the incidence of neonatal and clinical sepsis (17,000/1000 live births) is the highest in the world [6,7]. The case fatality rate of sepsis among neonates ranges from 25% to 65% in India [8,9]. Antibiotic resistance has become a global threat, and the spectrum of organisms that cause neonatal sepsis has changed over time and varies from region to region.…”