Title: Clinical and Epidemiological Profile of Neonatal Sepsis in Referral Care NICU in South Kerala
Authors: Dr Sanuja Sarasam E, Dr Geetha S, Dr Sobha Kumar.S
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.159
Abstract
Introduction: Neonatal sepsis continues to be a major cause for mortality and morbidity in neonates. It is 30 per 1000 live birth in India. The prevalence is more in preterm babies. As more preterm babies are now surviving.
Objective: To describe the clinical and bacteriologic spectrum of neonatal sepsis in referral neonatal intensive care unit.
Secondary objective: To compare risk factors and bacteriologic spectrum in early onset and late onset sepsis.
Setting: Tertiary care referral center in a teaching hospital in South Kerala.
Study period: January 2014 to December 2016.
Design: Retrospective cohort study.
Methods: All neonates admitted were assessed for bacterial sepsis.
Inclusion criteria included presence of one or more of the established clinical features, along with ≥2 of the laboratory criteria (total blood leukocyte count <5000/>15000, absolute neutrophil count (ANC) <500 cells/mm 3 or >1500/mm 3, immature to total neutrophil ratio >0.2, micro erythrocyte sedimentation rate (ESR) >15/1 h, C-reactive protein (CRP) >0.6 μg/ml, positive blood culture. Information assessed in a proforma. Cases were divided into early onset sepsis (EOS) (presenting in the first 72 h) and late onset sepsis (LOS) (presenting after 72 h).All cases were started on antibiotics and managed as per SAT hospital protocol and later upgraded or stopped based on culture and sensitivity. Cases were followed-up to discharge/death.
Results: There were 5202 admissions during study period. Of this 586 were of suspected sepsis.RDT was positive in 346 patients (59.04 %).Of these neonates 126 (36.4%) had culture positive sepsis. The incidence of culture positive sepsis was 126/546(21.5%). Of these 68(54%) was Early onset sepsis (EOS) and 58(46%) late onset sepsis (LOS). The total deaths were 353. Of these 9 deaths has culture positivity. The common organisms were Staphylococcus (35)27.8%, Klebsiella (25)19.8%, Acinetobacterium (24)19%, Pseudomonas (16)12.7% & E coli (8)6.3%, CONS (1) 1%.
Conclusion: The incidence of culture positive sepsis was 21.5%. Of these 54%was Early onset sepsis (EOS). The common organisms were Gram negative organisms in both EOS& LOS. Gram positive organism Staphylococcus aureus is also a major contributor in neonatal sepsis in our study. Acinetobacter sepsis is high (19%) in our study.
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Dr Sanuja Sarasam E
Asst. Professor Dept. of Pediatrics, Medical College Thiruvananthapuram, India
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