Neonatal sepsis: Highlighting the principles of diagnosis and management

Coetzee, M; Mbowane, N T; Witt, T W de

doi:10.7196/sajch.2017.v11i2.1244

Cited by 20 publications

(25 citation statements)

References 19 publications

(149 reference statements)

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“…Neonatal sepsis presents unique diagnostic challenges largely due to the absence of a universal definition [ 5 ]. Traditionally defined as sepsis within the first 28 days of life, neonatal sepsis can be further stratified into early-onset (< 3 days) and late-onset (≥ 3 days) [ 6 ]. It entails a collection of non-specific clinical features or laboratory signs of sepsis with positive microbiological cultures from a sterile sample (although cultures may sometimes be negative).…”

Section: Introductionmentioning

confidence: 99%

Neonatal sepsis in a tertiary unit in South Africa

et al. 2021

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Background Antimicrobial resistance (AMR) has emerged as a global threat to healthcare resulting in an increase in morbidity and mortality. Neonatal sepsis is ranked as the third highest cause of neonatal demise globally, in which AMR accounted for 31.0% of deaths. AMR in neonates has been poorly characterised in Durban, South Africa. Thus, the resultant effect of AMR on empiric regimens for neonatal sepsis is uncertain in this setting. Therefore, this study analysed the aetiology and antimicrobial susceptibility patterns of bloodstream infections within the neonatal intensive care unit at a tertiary hospital in Durban, with the aim of establishing an effective empiric regimen for the unit. Methods A retrospective data review on positive blood cultures from the neonatal intensive care unit at Inkosi Albert Luthuli Central Hospital was conducted. Three time periods were analysed: 2014, 2016 and 2018. Culture data from neonates aged 0–30 days were included and repeat cultures were de-duplicated. The frequency of common organisms and their antimicrobial susceptibilities were analysed. Fischer’s exact test was used for subgroup analysis. Poisson and logistic regressions were used to assess significant trends in organisms and antimicrobial susceptibilities over time. Results Late-onset sepsis (86.8%) predominated over early-onset sepsis (13.2%). A preponderance of gram-positive organisms (68.7%) over gram-negatives (26.8%) and fungi (4.5%) was detected. Common pathogens included coagulase-negative staphylococci (53.5%), Klebsiella pneumoniae (11.6%), enterococci (9.3%), and Acinetobacter baumannii (7.7%). Despite the small contribution of fungi to the microbial profile, fluconazole-resistant Candida parapsilosis predominated within that group. High rates of resistance to first- and second-line antibiotics were also noted among gram-positive and gram-negative organisms. Multidrug resistant organisms included extended-spectrum beta-lactamase (ESBL) K. pneumoniae (7.6%) and extensively-drug resistant A. baumannii (7.0%). However, a statistically significant decrease in ESBL-producing organisms was documented during the entire study period (p = 0.005). Conclusions It was determined that first-line antimicrobials, advocated by the World Health Organization for treatment of neonatal sepsis, proved ineffective in this unit due to high levels of AMR. Therefore, this study advises that meropenem with or without vancomycin provides optimal empiric cover. Amphotericin B is advocated for empiric antifungal therapy. Ongoing surveillance is necessary.

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Section: Introductionmentioning

confidence: 99%

Neonatal sepsis in a tertiary unit in South Africa

et al. 2021

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“… 1 , 2 It is a clinical syndrome characterized by systemic infections and the isolation of pathogens in the blood (bacteremia) and occurs in infants in the first month of life. 3 - 6 As many as 1.6 million neonates die each year due to infection with 60% of deaths occurring in developing countries. 7 Neonatal sepsis is reported as 1–5 per 1000 live births in developed countries, and a higher incidence is reported in developing countries (10–50 per 1000 live births).…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio as an Alternative Marker of Neonatal Sepsis in Developing Countries

2020

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Objectives: We sought to analyze the neutrophil-to-lymphocyte ratio (NLR) as an alternative marker of neonatal sepsis. Methods: In this cross-sectional study, we undertook consecutive sampling in all inborn neonates admitted to the Neonatal Intensive Care Unit with clinical manifestations of neonatal sepsis. Neonates with congenital anomalies and referred neonates were excluded. Complete blood count, C-reactive protein (CRP), and blood culture were carried out as the septic workup examinations based on the local Clinical Practical Guidelines. NLR is obtained by dividing the absolute count of neutrophils from lymphocytes manually. A cut-off value of NLR is obtained using a receiver operating characteristic curve. Results: The median NLR value of the 104 neonates who met the inclusion and exclusion criteria was 3.63 (2.39–6.12). Neonates with NLR of 2.12 have the area under the curve of 0.630 (95% confidence interval (CI): 0.528–0.741) and 0.725 (95% CI: 0.636–0.814) when combined with CRP = 2.70 mg/dL. Neonates with NLR ≥ 2.12 in clinical neotnatal sepsis had almost double the risk of providing positive blood culture results (relative risk = 1.867, 95% CI: 1.077–3.235; p =0.011). Conclusions: NLR, calculated from complete blood count, can be used as an alternative marker of easy and relatively inexpensive neonatal sepsis, especially in developing countries, and detection of proven neonatal sepsis to be better when combined with CRP.

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“…Neonatal sepsis is a syndrome featured by non-specific signs and symptoms of systemic infection accompanied by bacteremia in the first 28 days of extra uterine life (1). This condition is a public health problem that still contributes to mortality and morbidity in neonatal intensive care units (NICUs) in high (2)(3)(4), as well as low-and middle-income countries (5)(6)(7). Thus, in order to diminish neonatal deaths, early pharmacological therapy must be initiated; unfortunately, antibiotics are not specific, getting an accurate diagnosis even for experienced clinicians is difficult due to the non-specific signs and symptoms, and may take several days to get the culture test results (8,9).…”

Section: Introductionmentioning

confidence: 99%

Neonatal Sepsis Diagnosis Decision-Making Based on Artificial Neural Networks

Helguera-Repetto

Soto-Ramirez

Villavicencio-Carrisoza

et al. 2020

Front. Pediatr.

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Neonatal sepsis remains difficult to diagnose due to its non-specific signs and symptoms. Traditional scoring systems help to discriminate between septic or not patients, but they do not consider every single patient particularity. Thus, the purpose of this study was to develop an early-and late-onset neonatal sepsis diagnosis model, based on clinical maternal and neonatal data from electronic records, at the time of clinical suspicion. A predictive model was obtained by training and validating an artificial Neural Networks (ANN) algorithm with a balanced dataset consisting of preterm and term non-septic or septic neonates (early-and late-onset), with negative and positive culture results, respectively, using 25 maternal and neonatal features. The outcome of the model was sepsis or not. The performance measures of the model, evaluated with an independent dataset, outperformed physician's diagnosis using the same features based on traditional scoring systems, with a 93.3% sensitivity, an 80.0% specificity, a 94.4% AUROC, and a regression coefficient of 0.974 between actual and simulated results. The model also performed well-relative to the state-of-the-art methods using similar maternal/neonatal variables. The top 10 factors estimating sepsis were maternal age, cervicovaginitis and neonatal: fever, apneas, platelet counts, gender, bradypnea, band cells, catheter use, and birth weight.

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Neonatal sepsis: Highlighting the principles of diagnosis and management

Cited by 20 publications

References 19 publications

Neonatal sepsis in a tertiary unit in South Africa

Neonatal sepsis in a tertiary unit in South Africa

Neutrophil-to-Lymphocyte Ratio as an Alternative Marker of Neonatal Sepsis in Developing Countries

Neonatal Sepsis Diagnosis Decision-Making Based on Artificial Neural Networks

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