DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175012

Evaluation of perinatal factors in neonatal sepsis at tertiary centre

Raju Kumar, Anita Kumari, Anjili Kumari, Neelam Verma

Abstract


Background: Neonatal mortality in India continues to remain a major health problem. Neonatal infections are one of the major contributor to neonatal mortality causing approximately one-quarter of the deaths. The signs of neonatal sepsis may be non-specific and easily missed, especially in the early stages. A high index of suspicion and identification of both maternal and neonatal risk factors is an important for early identification and prompt treatment.

Methods: This is prospective study done at Patna medical college and hospital Patna from February 2014 to January 2015 in department of paediatrics. All inborn and out born neonates who had clinical signs of sepsis were included in the study.

Results: During the 1-year study period, there were a total of 910 admissions in the NICU, out of which 175 were admitted due to neonatal septicaemia. Incidence of neonatal septicaemia was approximately 20%. Mean age at presentation was 4.8±6.38). Low birth weight (60%), preter delivery (60.57%), male gender (66.85%) and low APGAR score at1 minute were common foetal risk factor and prolonged labour (41.14%) and multiple vaginal examination (36.57%), PROM in 28%, MSL (25.71%) were common maternal risk factors. Present study documented a culture positivity rate of 42.28%. E. coli (37.83%) was the most common isolated organism in early as well as LOS. Staphylococcus aureus (20.27%) was the most common isolated Gram-positive bacterium. Mortality rate was 45.14%. Mortality was more in preterm babies (57.54%) which was statically significant p value <0.001.

Conclusions: Neonatal septicemia is common and serious condition with high mortality rate. Since the condition starts with vague clinical signs, one has to keep very high index of suspicion to diagnose neonatal sepsis. Diagnosis and treatment at the early stage is very important for favorable outcome. Proper antenatal care, and institutional delivery may decrease neonatal sepsis.


Keywords


Antenatal care, Neonatal septicemia, Neonatal sepsis, Perinatal factors

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References


Estimates of mortality indicators-census of India. Available at http://www.censusindia.gov.in/vital statistics/srs/chap_4_- _2010.pdf. [Last accessed on 2015 Aug 15].

Million Death Study Collaborators, Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, et al. Causes of neonatal and child mortality in India: A nationally representative mortality survey. Lancet. 2010;376(9755):1853-60.

Kumhar GD, Ramachandran VG, Gupta P. Bacteriological analysis of blood culture isolates from neonates in a tertiary care hospital in India. J Health Popul Nutr. 2002;20(4):343-7.

Vinodkumar CS, Neelagund YF, Suneeta K, Sudha B, Kalappannavar NK, Basavarajappa KG. Perinatal risk factors and microbial profile of neonatal sepsis. J Obstet Gynecol India. 2008;58(1):32-40.

Thapa B, Thapa A, Aryal DR, Thapa K, Pun A, Khanal S, et al. Neonatal sepsis as a major cause of morbidity in a tertiary center in Kathmandu. JNMA. 2013;52:549-56.

Sharma D, Kumar C, Pandita A, Pratap OT, Dasi T, Murki S. Bacteriological profile and clinical predictors of ESBL neonatal sepsis. J Matern Fetal Neonatal Med. 2015:1-4.

Schuchat A, Zywicki SS, Dinsmoor MJ, Mercer B, Romaguera J, O’Sullivan MJ, et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: A multicenter case-control study. Pediatrics. 2000;105:21-6.

Muley VA, Ghadage DP, Bhore AV. Bacteriological profile of neonatal septicemia in a tertiary Care Hospital from Western India. J Glob Infect Dis. 2015;7:75-7.

Singh M, editor. Neonatal septicemia. Care of the Newborn. 7th ed. Philadelphia, PA: Sagar Publication;2009:223-9.

Ferrieri P, Wallen LD. Neonatal bacterial sepsis. In: Gleason CA, Deveskar SU, editors. Avery’s Diseases of the Newborn. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2011:538-50

Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. J Nat Sci Biol Med. 2013;4:306-9.

Leal YA, Álvarez-Nemegyei J, Velázquez JR, Rosado-Quiab U, Diego-Rodríguez N, Paz-Baeza E, et al. Risk factors and prognosis for neonatal sepsis in southeastern Mexico: Analysis of a four-year historic cohort follow-up. BMC Pregnancy Childbirth. 2012;12:48.

Kuruvilla KA, Pillai S, Jesudason M, Jana AK. Bacterial profile of sepsis in a neonatal unit in South India. Indian Pediatr. 1998;35(9):851-8.

Desai KJ, Malek SS, Parikh A. Neonatal. Septicemia: Bacterial isolates and their antibiotic susceptibility patterns. Gujarat Med J. 2011;66(1):13-5.

Chow AW, Leake RD, Yamauchi T, Anthony BF, Guze LB. The significance of anaerobes in neonatal bacteremia: Analysis of 23 cases and review of the literature. Pediatrics. 1974;54(6):736-45.

National neonatal perinatal database-WHO Newborn CC. Available at http://www.newbornwhocc.org/pdf/nnpd_ report_2002-03.PDF. [Last accessed on 2015 Aug 15].

Tsering DC, Chanchal L, Pal R, Kar S. Bacteriological profile of septicemia and the risk factors in neonates and infants in Sikkim. J Glob Infect Dis. 2011;3(1):42-5.

Mathur NB. Neonatal sepsis. Indian Pediatr. 1996;33:663-74.

Areen A, Mahajan K, Singh S. Impact of JSY scheme on incidence of low birth weight in a rural tertiary Care Hospital in Punjab. Indian J Matern Child Health. 2012;14(1):7.