The clinical spectrum and outcome of neonatal sepsis in a neonatal intensive care unit at a tertiary care hospital in western Nepal: January 2000 to December 2005 - A retrospective study.

Yıl 2012, Cilt: 17 Sayı: 3, 119 - 125, 09.10.2014

Chandan Kumar Shaw Prachi Shaw Tejesh Malla Kalpana K. Malla

Öz

Abstract. Sepsis is the commonest cause of neonatal mortality. However the incidence of the latter varies with the geographical area, the socio-economic structure and various customs and practices in the perinatal period. Till date there have been no published data regarding the latter in Nepal. With the neonatal services coming of age in Nepal it becomes pertinent to study the magnitude and characteristics of the burden of neonatal sepsis. We conducted a retrospective study over a period of six years to elucidate the risk factors, clinical spectrum, diagnostic parameters and the outcome of neonatal sepsis at a tertiary care neonatal intensive care unit. In all 265 cases of suspected sepsis were screened using a panel consisting of C – reactive protein, absolute neutrophil count and immature to total neutrophil count ratio and subsequently confirmed by cultures. The cases were early onset (n=44), late onset (n=56) and nosocomial groups (n=40). The data for the intramural (n=32) and extramural (n=68) cases was analyzed separately. In all 265 neonates (male: female = 1.86:1) were screened for sepsis, out of which 183 resulted a positive screen, of which, 100 had pathogenic organisms (37.76%). Prematurity (22 to 71%) was most frequently associated with all the categories: suspect, early onset, late onset, nosocomial, irrespective of whether they were in- or out-born. The major risk factor associated with out-born babies was asepsis during labour (57.4%). Respiratory signs and symptoms were commoner in the in-borns as well as the nosocomials. The commonest complication associated with neonatal sepsis in our study was exaggeration of neonatal jaundice/hepatitis (80 to 92%). The sensitivity and specificity for C – reactive protein, immature to total neutrophil count and absolute neutrophil count were found to be 93% and 49.7%, 36% and 75.6% and 20% and 83.4% respectively. Among the culture positive neonates (n=100), 32 were in-house deliveries, and the rest were out-born. The frequency of early and late-onset sepsis was similar. In all there were 131 isolates from blood, cerebrospinal fluid and urine, out of which 38 (29.0%) were in the in-born babies. Nosocomial sepsis accounted for 44 (33.59 %) of the isolates out of both the in and out-born babies combined. The mortality (10%) and sequelae (7.5%) was higher in the nosocomial sepsis group. We observed that there is a high rate of aseptic home deliveries. Nosocomial sepsis was an important problem in the study though the outcome was not un-encouraging. There is a need for extension and intensification of the maternal and child health services in Nepal.

Key words: Extramural and nosocomial septicemia, intramural, neonatal sepsis

Anahtar Kelimeler

-

Kaynakça

• National Neonatology Forum: National Neonatology Database: Report. Indian Pediatr 1989; 36: 167-169.
• Stoll BJ. Infections of the neonatal infant. In: Behrman RE, Kleigman RM, Jenson HB (eds.) Nelson textbook of pediatrics.17th ed. Philadelphia Saunders 2004; p 623-640.
• Stoll BJ. The global impact of neonatal infection. Clin Perinatol 1997; 24: 1-21.
• Paul VK, Ramani AV. Newborn care at peripheral health care facilities. Indian J Pediatr 2000; 67: 378- 382.
• Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979; 95: 89-98.
• Oddie S, Embleton ND. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. BMJ 2002 10; 325: 308.
• Singh M, Paul VK, Deorari AK, et al. Strategies which reduced sepsis-related neonatal mortality. Indian J Pediatr 1988; 55: 955-960.
• Verboon-Maciolek MA, Thijsen SF, Hemels MA, et al. Inflammatory mediators for the diagnosis and treatment of sepsis in early infancy. Pediatr Res 2006; 59: 457-461.
• Doellner H, Arntzen KJ, Haereid PE, Aag S, Austgulen R. Interleukin-6 concentrations in neonates evaluated for sepsis. J Pediatr 1998; 132: 295-299.
• Adams-Chapman I, Stoll BJ. Systemic inflammatory response syndrome. Semin Pediatr Infect Dis 2001; 12: 5-8.
• Ohlsson A, Lacy JB. Intravenous immunoglobulin for preventing infection in preterm and/or low-birth- weight infants. Cochrane Database Syst Rev 2004; (1):CD000361.
• Suri M, Harrison L, Van de Ven C, Cairo MS. Immunotherapy in the prophylaxis and treatment of neonatal sepsis. Curr Opin Pediatr 2003; 15: 155- 160.
• Sandberg K, Fasth A, Berger A, et al. Preterm infants with low immunoglobulin G levels have increased risk of neonatal sepsis but do not benefit from prophylactic immunoglobulin G. J Pediatr 2000; 137: 623-628.
• Hill HR. Additional confirmation of the lack of effect of intravenous immunoglobulin in the prevention of neonatal infection. J Pediatr 2000; 137: 595-597.
• INIS Collaborative Group, Brocklehurst P, Farrell B, et al. Treatment of neonatal sepsis with intravenous immune globulin. N Engl J Med 2011; 365: 1201-1211.
• Mathur NB, Subramanian BK, Sharma VK, Puri RK. Exchange transfusion in neutropenic septicemic neonates: effect on granulocyte functions. Acta Paediatr 1993; 82: 939-943.
• Klinger G, Chin CN, Beyene J, Perlman M. Predicting the outcome of neonatal bacterial meningitis. Pediatrics 2000; 106: 477-482.
• DaSilva O, Ohlsson A, Kenyon C. Accuracy of leukocyte indices and C-reactive protein for diagnosis of neonatal sepsis: a critical review. Pediatr Infect Dis J 1995; 14: 362-366.
• Fowlie PW, Schmidt S. Diagnostic tests for bacterial infections from birth to 90 days: a systematic review.Arch Dis Child Fetal Neonatal Ed 1998; 78: 92-98.
• Gerdes JS, Polin RA. Early diagnosis and treatment of neonatal sepsis. Indian J Pediatr 1998; 65: 63-78.
• Gerdes JS. Clinicopathologic approach to the diagnosis of neonatal sepsis. Clin Perinatol 1991; 18: 361-381.
• Weinberg GA, Powell KR. Laboratory aids for diagnosis of neonatal sepsis. In: Remington JS, Klein JS (eds). Infectious diseases of the fetus and the newborn infant, 5th ed. Philadelphia WB Saunders 2001; p1327-1344.
• Nuntnarumit P, Pinkaew O, Kitiwanwanich S. Predictive values of serial C-reactive protein in neonatal sepsis. J Med Assoc Thai 2002; 85: 1151- 1158.
• Al-Zwaini EJ. C-reactive protein: a useful marker for guiding duration of antibiotic therapy in suspected neonatal septicaemia? East Mediterr Health J 2009; 15: 269-275.
• Molloy EJ, O'Neill AJ, Grantham JJ, et al. Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor have differential effects on neonatal and adult neutrophil survival and function. Pediatr Res 2005; 57: 806-812.
• Carr R, Modi N, Doré C. G-CSF and GM-CSF for treating or preventing neonatal infections. Cochrane Database Syst Rev 2003; (3):CD003066.
• Ahmad A, Laborada G, Bussel J, Nesin M. Comparison of recombinant granulocyte colony- stimulating factor, recombinant human granulocyte- macrophage colony-stimulating factor and placebo for treatment of septic preterm infants. Pediatr Infect Dis J 2002; 21: 1061-1065.
• Engle WD, Rosenfeld CR, Mouzhino A, et al. Circulating neutrophils in septic preterm neonates: Comparison of two reference ranges. Pediatrics 1997; 99: 10-12.
• Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110: 285-291.
• Wu YW, Colford JM Jr. Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis. JAMA 2000; 284: 1417-1424.
• Grether JK, Nelson KB. Maternal infection and cerebral palsy in infants of normal birth weight. JAMA 1997; 278: 207-211.