Factors Associated with Neonatal Sepsis: A Case Study at Chilenje General Hospital in the Neonatal Unit and Paediatric Wards

Background: Neonatal sepsis is known to result in 26% of mortalities in children below the age of five worldwide, countries in Sub-Saharan African recording the highest deaths. Although the deaths of neonates have reduced world over up to 3.6 million counts, Chilenje General Hospital continues to register significant numbers of neonatal sepsis. This study aimed at investigating the factors associated with neonatal sepsis at Chilenje General Hospital in Lusaka, Zambia. Methods: An institution based cross-sectional study design was conducted at Chilenje General Hospital. Data were collected by the use of a researcher designed questionnaire and analysed using SPSS version 25. Frequencies were used for descriptive analysis while bivariate analysis was used to establish association among risk factors and outcome variables. Variables with significant association at 5% level were further subjected to multivariate analysis at α ≤ 0.05. Results: The study showed that out of 156 neonates, 40.4% (63/156) developed neonatal sepsis. Maternal factors that projected the incidence of sepsis amongst neonates were distance to nearest health facility [AOR: 6.3 (95% CI: 1.8 - 21.3), p = 0.003], occupation [AOR: 5.8 (95% CI: 1.2 - 27.6), p = 0.026], number of antenatal visits [AOR: 6.3 (95% CI: 1.9 - 21.6), p = 0.003], number of vaginal examinations [AOR: 10.8 (95% CI: 2.8 - 42), p = 0.001], and pregnancy induced hypertension [AOR: 5.4 (95% CI: 1.4 - 20), p = 0.013]. Neonatal risk factor which projected the incidence of sepsis was Neonate’s age [AOR: 18.8 (95% CI: 4.9 - 72.5), p = 0.000]. Conclusions: The chance of developing neonatal sepsis was strongly correlated with both mother and child variables, according to the study. In order to lower the chance of the neonate acquiring sepsis, encouraging maternal antenatal care use would assist to detect risk factors during prenatal, perinatal and postnatal care and apply the proper therapies.

Diagnostic significance of complete blood cell count and hemogramderived markers for neonatal sepsis at Southwest Public Hospitals,Ethiopia

BACKGROUND Neonatal sepsis is defined as an infection-related condition characterized by signs and symptoms of bacteremia within the first month of life.It is the leading cause of mortality and morbidity among newborns.While several studies have been conducted in other parts of world to assess the usefulness of complete blood count parameters and hemogram-derived markers as early screening tools for neonatal sepsis,the associations between sepsis and its complications with these blood parameters are still being investigated in our setting and are not yet part of routine practice.AIM To evaluate the diagnostic significance of complete blood cell count hemogramderived novel markers for neonatal sepsis among neonates attending public hospitals in the southwest region of Oromia,Ethiopia,through a case control study.METHODS A case control study was conducted from October 2021 to October 2023 Sociodemographic,clinical history,and laboratory test results data were collected using structured questionnaires.The collected data were entered into Epi-data 3.1 version and exported to SPSS-25 for analysis.Chi-square,independent sample ttest,and receiver operator characteristics curve of curve were used for analysis.A P-value of less than 0.05 was considered statistically significant.RESULTS In this study,significant increases were observed in the following values in the case group compared to the control group:In white blood cell(WBC)count,neutrophils,monocyte,mean platelet volume(MPV),neutrophils to lymphocyte ratio,monocyte to lymphocyte ratio(MLR),red blood cell width to platelet count ratio(RPR),red blood width coefficient variation,MPV to RPR,and platelet to lymphocyte ratio.Regarding MLR,a cut-off value of≥0.26 was found,with a sensitivity of 68%,a specificity of 95%,a positive predictive value(PPV)of 93.2%,and a negative predictive value(NPV)of 74.8%.The area under the curve(AUC)was 0.828(P<0.001).For WBC,a cutoff value of≥11.42 was identified,with a sensitivity of 55%,a specificity of 89%,a PPV of 83.3%,and a NPV of 66.4%.The AUC was 0.81(P<0.001).Neutrophils had a sensitivity of 67%,a specificity of 81%,a PPV of 77.9%,and a NPV of 71.1%.The AUC was 0.801,with a cut-off value of≥6.76(P=0.001).These results indicate that they were excellent predictors of neonatal sepsis diagnosis.CONCLUSION The findings of our study suggest that certain hematological parameters and hemogram-derived markers may have a potential role in the diagnosis of neonatal sepsis.

Plasma D-dimer level in early and late-onset neonatal sepsis

BACKGROUND Neonatal sepsis is a life-threatening disease.Early diagnosis is essential,but no single marker of infection has been identified.Sepsis activates a coagulation cascade with simultaneous production of the D-dimers due to lysis of fibrin.Ddimer test reflects the activation of the coagulation system.AIM To assess the D-dimer plasma level,elaborating its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis.METHODS The study was a prospective cross-sectional study that included ninety neonates;divided into three groups:Group I:Early-onset sepsis(EOS);Group II:Late-onset sepsis(LOS);and GroupⅢ:Control group.We diagnosed neonatal sepsis according to our protocol.C-reactive protein(CRP)and D-dimer assays were compared between EOS and LOS and correlated to the causative microbiological agents.RESULTS D-dimer was significantly higher in septic groups with a considerably higher number of cases with positive D-dimer.Neonates with LOS had substantially higher levels of D-dimer than EOS,with no significant differences in CRP.Neonates with LOS had a significantly longer hospitalization duration and higher gram-negative bacteriemia and mortality rates than EOS(P<0.01).Gramnegative bacteria have the highest D-dimer levels(Acinetobacter,Klebsiella,and Pseudomonas)and CRP(Serratia,Klebsiella,and Pseudomonas);while gram-positive sepsis was associated with relatively lower levels.D-dimer had a significant negative correlation with hemoglobin level and platelet count;and a significant positive correlation with CRP,hospitalization duration,and mortality rates.The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L,giving a sensitivity of 72.7%and specificity of 86.7%.The D-dimer assay has specificity and sensitivity comparable to CRP in the current study.CONCLUSION The current study revealed a significant diagnostic value for D-dimer in neonatal sepsis.D-dimer can be used as an adjunct to other sepsis markers to increase the sensitivity and specificity of diagnosing neonatal sepsis.

Measurements of C-Reactive Protein for Successful Management and Follow-Up Treatment of Neonatal Sepsis and Nosocomial Infection

Objective: To develop an optimal follow-up treatment for neonatal and nosocomial infections and to examine correlations between the C-reactive protein (C-RP) and platelets. Methods: A sample of 27 septic neonates and 14 non-septic neonates were selected for this study. The non-septic neonates served as a control group. Blood samples were collected from both groups and analyzed for bacterial contamination via blood culture, complete blood count (CBC), and C-RP, according to international laboratory standards. Blood collection and analysis were repeated every day during the follow-up treatments with antibiotics to evaluate the kinetics of C-RP. Results: Blood culture found E. coli and Staphylococcus aureus in the blood of the septic cases. Serum C-RP concentrations were at high levels (24 mg/dl) in the septic neonates and at normal levels (lower than 6 mg/dl) in the control group. Treatment with active antibiotics resulted in a drastic reduction of the C-RP values and helped to reach a normal level as in the control group. On the other hand, there were increases in the platelet levels as the C-RP levels decreased. This result indicates a strong negative association between C-RP and platelet levels in the septic group only. Statistical analysis shows significant differences between the mean C-RP serum concentrations of the sepsis and non-sepsis. Conclusion: blood culture, active antibiotics, and kinetic C-RP measurements during the medical follow-up treatment are strong driving parameters for the optimal and successful management of sepsis.

Retrospective Epidemiological Investigation on Nosocomial Neonatal Sepsis in Shaanxi Province (2008-2010)

Objective: This study assessed the incidence, mortality, and pathogens associated with nosocomial neonatal sepsis (NNS) in Shaanxi Province to improve the prevention and control of NNS. Methods: Nine large neonatal departments in Shaanxi Province participated in this retrospective epidemiological investigation of NNS during the period of 2008-2010, using standardized protocol. The incidence, mortality, pathogens, antibiotic sensitivity, clinical characteristics, prognosis, and costs were analyzed. Results: Of 16,642 neonates admitted to neonatal departments in the 9 hospitals during 2008-2010, there were 139 cases of NNS, with incidence of 8.3% and mortality of 20.8%. The predominant pathogens were Gram-negative bacteria, accounting for 67.6% of positive cultures. Gram-positive bacteria accounted for 24.5% and fungal infection accounted for 7.9%. The most common Gram-negative species were Klebsiella pneumonia (22.3%), Escherichia coli (15.1%), and Enterobacter cloacae (8.6%). The dominant Gram-positive species identified were coagulase negative staphylococcal species (CONS) (8.6%), followed by Staphylococcus aureus (7.9%). The recovered bacterial pathogens demonstrated varying antibiotic resistance, but no meropenem-or-vancomycin-resistant strains were detected. Preterm and full-term infants showed significant difference in clinical manifestations, laboratory findings, mortality, and cost. Conclusion: NNS in the hospitals of Shaanxi Province showed a decreasing trend from 2008 to 2010, but the mortality did not reduce significantly. The predominant bacteria were Gram negative, and pathogens were found to have varying antibiotic resistance. The preterm group had higher mortality and costs than the full-term infants. Therefore, effective measures should be taken to control NNS, especially in preterm infants.

Role of intravenous immunoglobulin in suspected or proven neonatal sepsis

Neonatal sepsis remains the major cause of mortality and morbidity including neurodevelopmental impairment and prolonged hospital stay in newborn infants. Despite of advances in technology and optimal antibiotic treatment,incidence of neonatal sepsis and its complications remains unacceptably high especially in developing countries. Premature neonates in particular are at higher risk due to developmentally immature host defence mechanisms. Though not approved by Food and Drug Administration(FDA) U. S. A,off label use of intravenous immunoglobulin as prophylactic or adjuvant agent in suspected or proven neonatal infections continues in many countries. In a recent large multicenter clinical trial by International Neonatal Immunotherapy Study(INIS) group, the use of polyvalent IgG immune globulin was not associated with significant differences in the risk of major complications or other adverse outcomes in neonates with suspected or proven sepsis. Hence,use of intravenous immunoglobulin in suspected or proven neonatal sepsis is not recommended. The expense of prophylactic use of intravenous immunoglobulin administration for both term and preterm newborn population,given the minimal benefit as demonstrated by many individual studies and by meta-analysis is not justified.

Platelet indices in neonatal sepsis: A review

Thrombocytopenia is a common hematological abnormality in neonates with sepsis. The autoanalyzers now-a-days readily provide platelet indices along with platelet counts without any additional cost. However these indices are not given proper weightage often.The important platelet indices available for clinical utility include mean platelet volume(MPV), platelet distribution width and plateletcrit that are related to morphology and proliferation kinetics of platelets. Studies in adult patients reported their role in the diagnosis of severe sepsis and prognosis of adverse clinical outcomes including mortality. Abnormal MPV can aid diagnosing the cause of thrombocytopenia. Low MPV associated with thrombocytopenia has been found to result in clinical bleeding.Other indices, however, are less studied. The studies addressing the importance of these platelet indices in neonatal sepsis are limited. The current review gives an overview of potential utility of important platelet indices in neonatal sepsis.

Prevalence and Predictors of Neonatal Sepsis among Neonates Admitted at the Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya

Background: Neonatal sepsis is one of the primary causes of neonatal morbidity and mortality especially in developing countries. Despite the availability of different preventive interventions, in Kenya, the burden of neonatal sepsis remains critically high. Aim: To determine the prevalence and predictors of neonatal sepsis among newborns admitted at the newborn unit of Kenyatta National Hospital, Kenya. Methods: This is a hospital-based, cross-sectional study design carried out among 196 neonates and their mothers at the new born unit of Kenyatta National Hospital. A systematic random sampling technique was employed to select the study subjects. Data on the possible contributing factors of neonatal sepsis was collected using a semi-structured questionnaire. Statistical analyses were performed using the statistical package for the Social Sciences (SPSS: version 22). Data were descriptively analyzed into frequencies and proportions. The chi-square test of independence and binary logistic regression were employed to determine associations between the dependent (neonatal sepsis) and various independents variables. A multiple logistic regression model was carried out to determine the variables independently contributed to the occurrence of neonatal sepsis. Results: Our study revealed that the prevalence of neonatal sepsis was 28.6%. Neonates born of single mothers (AOR = 5.454, p = 0.012), mothers with history of UTI (AOR = 2.969, p = 0.013), PROM (AOR = 6.124, p = 0.001) and anaemia (AOR = 3.379, p = 0.010) were at higher risk to develop neonatal sepsis. Prematurity (AOR = 6.402, p < 0.001), low Apgar score at 5th minutes (AOR = 8.212, p < 0.001) and history of invasive procedure (AOR = 2.464, p = 0.046) were the neonatal factors independently associated with neonatal sepsis. Conclusion and Recommendations: The prevalence of neonatal sepsis in Kenyatta National Hospital is high. This is another piece of evidence showing both maternal and neonatal-related factor had a significant effect on the risk of neonatal sepsis. Provision of community-based health education is highly recommended to increase awareness of women on the risk factors of neonatal sepsis and their preventive methods such as anaemia and UTI during pregnancy. Healthcare providers should exercise a high standard of care when handling premature and babies with low Apgar score to reduce the risks of neonatal sepsis.

Neonatal and Young Infant Sepsis in a Regional Hospital in Ghana

Background: Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital. Methods: A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050® machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via tuf gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2. Results: Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by Klebsiella pneumoniae in two and Staphylococcus aureus, Streptococcus agalactiae, the Acinetobacter species, and Escherichia coli in the rest (one each). Of the CoNS, S. haemolyticus and S. epidermidis were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. Conclusions: These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.

MBL2 Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

Mannose binding lectin (MBL) is an important component of innate immunity particularly in neonates whose adaptive immunity is not fully developed. Polymorphism in MBL2 gene promoter and exon1 determines MBL serum level and function. The aim of this study was to investigate the frequency of different MBL2 genotypes in neonatal sepsis among patients of neonatal intensive care unit (NICU). Two hundred and forty-five neonates were enrolled in this study (127 infected and 118 uninfected controls). Multiplex PCR and double amplification refractory mutation system (dARMS) were used for typing of MBL2 exon1 and promoter respectively. Klebsiella species were the most frequently isolated organisms (22.8%). There is no statistical significance difference in the distribution of different expression genotypes between infected group and controls (P = 0.11). However, prevalence of low MBL2 expression genotypes (XA/O and O/O) was higher in infected patients compared to control group (patients 25.2% and controls 15.3%). Low and medium MBL2 expression genotypes were mostly associated with Gram-negative bacterial infections (18.9% and 22.8%) respectively. A statistically significant association of Gram-negative bacterial infections with low MBL2 expression genotypes was found (P = 0.02). Higher frequency of AB and BB genotypes was observed (31.5% and 7.9%) in patients group compared to control, but without statistical significant difference.

Early neonatal sepsis at tertiary care teaching hospital

Objective:To study organisms in cases of early neonatal sepsis,and sensitivity patterns of these isolates.Methods:All pregnant mothers admitted from Jan 2006-Dec 2006 were registered.Neonates delivered at the hospital were examined upto 72 hours of birth,with special emphasis on the signs and symptoms of suspected sepsis.Neonates with no maternal or neonatal risk factor were included in the study,blood examination and appropriate cultures were taken.Antibiotics as cephatexime and amikacin were started on empirical bases until final cultures report was received.In cases of negative cultures,antibiotics were stopped.Other wise it continued according to culture and sensitivity for 10 to 14 days.Results:Among these 257 cases,113 neonates full filled our criteria.Staph aureus being the commonest organism in our study(59.29%)followed by Klebsiella pneumoniae(19.47%)and Entrococci(19.47%).These findings are not consistent with other studies in the country.Conclusion:Neonatal sepsis is a major cause of mortality and morbidity.Choice of antibiotic should depend on the local studies from time to time.

Salivary C-reactive protein and mean platelet volume as possible diagnostic markers for late-onset neonatal pneumonia

BACKGROUND Neonatal sepsis,a formidable threat to newborns,is a leading cause of neonatal mortality,with late-onset sepsis manifesting after 72 hours post-birth being particularly concerning.Pneumonia,a prevalent sepsis presentation,poses a significant risk,especially during the neonatal phase when lung defenses are compromised.Accurate diagnosis of pneumonia is imperative for timely and effective interventions.Saliva,a minimally invasive diagnostic medium,holds great promise for evaluating infections,especially in infants.AIM To investigate the potential of serum C-reactive protein(CRP),salivary CRP(sCRP),and mean platelet volume(MPV)as diagnostic markers for late-onset neonatal pneumonia(LONP).METHODS Eighty full-term neonates were systematically examined,considering anthropometric measurements,clinical manifestations,radiology findings,and essential biomarkers,including serum CRP,sCRP,and MPV.RESULTS The study reveals noteworthy distinctions in serum CRP levels,MPV,and the serum CRP/MPV ratio between neonates with LONP and healthy controls.MPV exhibited a robust discriminatory ability[area under the curve(AUC)=0.87]with high sensitivity and specificity at a cutoff value of>8.8.Correlations between serum CRP,sCRP,and MPV were also identified.Notably,sCRP demonstrated excellent predictive value for serum CRP levels(AUC=0.89),underscoring its potential as a diagnostic tool.CONCLUSION This study underscores the diagnostic promise of salivary and serum biomarkers,specifically MPV and CRP,in identifying and predicting LONP among neonates.These findings advocate for further research to validate their clinical utility in larger neonatal cohorts.

The correlation of PCT, SAA and CD64 levels in peripheral blood with the inflammatory response and viscera function in neonate with sepsis

Objective:To study the correlation of PCT, SAA and CD64 levels in peripheral blood with the inflammatory response and viscera function in neonate with sepsis.Methods: A total of 35 neonates diagnosed with sepsis in our hospital between March 2014 and March 2016 were selected as the sepsis group of the study, 60 healthy neonates born in our hospital during the same period were selected as the control group, peripheral blood samples were collected to determine the levels of PCT, SAA, CD64 as well as inflammatory factors, myocardial injury marker molecules and liver injury marker molecules.Results:PCT, SAA, CD64, sTREM-1, TNF-α, IL-6, IL-8, cTnI, cTnT, H-FABP, CK-MB, AST, ALT, GGT, TBIL and DBIL levels in peripheral blood of sepsis group were significantly higher than those of control group;PCT, SAA and CD64 levels in peripheral blood were positively correlated with sTREM-1, TNF-α, IL-6, IL-8, cTnI, cTnT, H-FABP, CK-MB, AST, ALT, GGT, TBIL and DBIL levels. Conclusion: PCT, SAA and CD64 levels in peripheral blood of neonatal sepsis significantly increase and are associated with the degree of inflammation, myocardial injury and liver injury.

Congenital sepsis caused by <i>Eikenella corrodens</i>

Eikenella corrodens is a part of normal human oral flora and a rare cause of intrauterine and neonatal infections. We describe a case of congenital E. corrodens sepsis with positive blood cultures at birth in the setting of low maternal risk factors for infection. Our case is one of two reported cases of congenital E. corrodens sepsis resulting in newborn survival.

Bacteriological Profile, Antimicrobial Susceptibility Patterns and Predictors of Bacteremia in Neonates with Clinical Sepsis at KCMC Hospital, Northern Tanzania

Background: Despite a significant decline in neonatal deaths in the last 20 years (5 million in 1990 to 2.4 million in 2019), the risk of death is still high, especially in developing countries. In Tanzania, neonatal sepsis is the third leading cause of neonatal death, accounting for 25% of all deaths. The rising global threat of antimicrobial resistance and the rising burden of neonatal death due to neonatal sepsis have been of great concern and have delayed progress toward reaching SDG goal 3.2 by 2030. This study aims to determine the bacteriological profile, antibiotic susceptibility patterns, and predictors of bacteremia among neonates with clinical sepsis at KCMC Hospital in Northern Tanzania. Methodology: This study had a cross-sectional design conducted at KCMC Hospital, Northern Tanzania. The study population was neonates admitted to the neonatal unit at KCMC Hospital. Data were collected using questionnaires and blood cultures from neonates. Frequencies and proportions were used to summarize categorical variables, while continuous variables were summarized using mean and standard deviation. The frequencies and proportions of bacteria isolated and the antimicrobial susceptibility results were analyzed and compared using Pearson’s chi-square test and Fisher’s exact test where applicable. Modified Poisson regression model was used to determine factors associated with positive blood culture. Results: Out of 411 neonates with a clinical diagnosis of neonatal sepsis, 175 (42.9%) had positive blood cultures. Gram-positive bacteria were most frequently isolated at 52.3%, and gram-negative bacteria were 47.7%. Coagulase-negative Staphylococcus (30.7%) and Staphylococcus aureus (19.9%) were the predominant gram-positive isolates. Gram-negative isolates were Klebsiella spp 47 (26.7%), E. coli 10 (5.7%), and Citrobacter spp 10 (5.1%). The gram-positive isolates were sensitive to vancomycin, piperacillin/tazobactam, and ceftazidime, whereas the gram-negative were sensitive to amikacin, meropenem, and vancomycin. The study did not find statistically significant associations between clinical factors and positive blood cultures in bacteremia. Conclusion: Gram-positive bacteria are the dominant pathogens in early-onset and late-onset neonatal sepsis. High levels of resistance to ampicillin and ceftriaxone and moderate resistance to gentamycin were observed in both gram-positive and gram-negative bacteria. Gram-positive organisms exhibit better susceptibility rates to vancomycin and ciprofloxacin, while gram-negative micro-organisms are more sensitive to amikacin and meropenem. An effective initial treatment approach for neonatal sepsis would involve a combination of drugs.

Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds

Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,between CG149 National Institute for Health and Care Excellence(NICE)guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator(SRC)in a level 2 neonatal unit at a district general hospital(DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS,neonatal clinical examination findings,and microbial culture results for all neonates born at≥34 weeks’gestation between February and July 2019,who were(1)managed according to CG149-NICE guidelines or(2)received PAb within 72 h following birth at a DGH in Winchester,UK.SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period.Of these,19(31.7%)met SRC criteria for antibiotics;20(33.3%)met the criteria for enhanced observations and none had culture-proven sepsis.Based on SRC projections,neonates with’’≥1 NICE clinical indicator and≥1 risk factor’were most likely to have a sepsis risk score(SRS)>3.Birth below 37 weeks’gestation(risk ratio[RR]=2.31,95%confidence interval[CI]:1.02–5.22)and prolonged rupture of membranes(RR=3.14,95%CI:1.16–8.48)increased the risk of an SRS>3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68%in term and near-term neonates in level 2 neonatal units.

Neonatal sepsis: within and beyond China

Sepsis remains a significant cause of neonatal morbidity and mortality in China.A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally.Literature cited in this review was retrieved from PubMed using the keywords"neonatal sepsis,""early-onset(EOS)"and"late-onset(LOS)"in English,with the focus set on population-based studies.This review provides an updated summary regarding the epidemiology,pathogen profile,infectious work-up,and empirical treatment of neonatal sepsis within and beyond China.The incidence of neonatal EOS and the proportion of Group B Streptococcus(GBS)within pathogens causing EOS in China seem to differ from those in developed countries,possibly due to different population characteristics and intrapartum/postnatal health care strategies.Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable.The pathogen profile of LOS in China was shown to be similar to other countries.However,viruses as potential pathogens of neonatal LOS have been underappreciated.Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections.This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution.A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis.Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.

Group B Streptococcus causes severe sepsis in term neonates:8 years experience of a major Chinese neonatal unit

Background:In contrast to industrialized countries,the clinical characteristics of neonatal sepsis caused by Group B Streptococcus (GBS) are largely unexplored in China.Methods:A retrospective case series study was performed at a high-capacity neonatal unit in Shanghai,China from January 2008 to December 2015.Clinical characteristics of neonates with culture-proven GBS sepsis and antibiotic susceptibility of isolated strains were analyzed.Results:Forty-three term neonates were included during the study period.The majority (74.4%) had early-onset sepsis with symptoms of respiratory distress.Meningitis was significantly more common in lateonset sepsis than in early-onset sepsis (81.5% vs.18.8%,P<0.0001).Approximately one third of all patients (n=16)developed severe sepsis,defined as sepsis with organ dysfunctions,and respiratory dysfunction/failure was the most common (32.6%).The in-hospital mortality rate of GBS sepsis was 4.7%.Neonates who progressed to severe sepsis had significantly lower pH level at the onset of symptoms than those who did not (7.26±0.12 vs.7.39±0.05,P=-0.006).Treatment of severe GBS sepsis required lots of medical resources including extracorporeal membrane oxygenation.All tested GBS strains were susceptible to penicillin,but the rate of resistance to clindamycin (84.0%) and erythromycin (88.0%) was high.Conclusions:GBS as a pathogen for neonatal sepsis has been receiving little attention in China.Our data demonstrated that GBS sepsis was likely to be fulminant.Early recognition followed by antibiotics and adequate supportive therapies was critical for successful treatment.Chinese clinicians should be aware of GBS infection when treating neonatal sepsis,especially in the absence of universal maternal GBS screening.

Prediction modelling in the early detection of neonatal sepsis

Background Prediction modelling can greatly assist the health-care professionals in the management of diseases,thus sparking interest in neonatal sepsis diagnosis.The main objective of the study was to provide a complete picture of performance of prediction models for early detection of neonatal sepsis.Methods PubMed,Scopus,CINAHL databases were searched and articles which used various prediction modelling measures for the early detection of neonatal sepsis were comprehended.Data extraction was carried out based on Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist.Extricate data consisted of objective,study design,patient characteristics,type of statistical model,predictors,outcome,sample size and location.Prediction model Risk of Bias Assessment Tool was applied to gauge the risk of bias of the articles.Results An aggregate of ten studies were included in the review among which eight studies had applied logistic regression to build a prediction model,while the remaining two had applied artificial intelligence.Potential predictors like neonatal fever,birth weight,foetal morbidity and gender,cervicovaginitis and maternal age were identified for the early detection of neonatal sepsis.Moreover,birth weight,endotracheal intubation,thyroid hypofunction and umbilical venous catheter were promising factors for predicting late-onset sepsis;while gestational age,intrapartum temperature and antibiotics treatment were utilised as budding prognosticators for early-onset sepsis detection.Conclusion Prediction modelling approaches were able to recognise promising maternal,neonatal and laboratory predictors in the rapid detection of early and late neonatal sepsis and thus,can be considered as a novel way for clinician decisionmaking towards the disease diagnosis if not used alone,in the years to come.

Association between innate immunity gene polymorphisms and neonatal sepsis development:a systematic review and meta-analysis

Background The aim of this meta-analysis was to analyze all available data from studies investigating associations between polymorphisms in genes responsible for innate immunity and neonatal sepsis development.Methods A comprehensive literature search,reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-S guidelines,was performed with no language restriction.Studies derived using the PICO(population,intervention,comparison and outcomes)strategy,with data on the genotype distribution for innate immunity gene polymorphisms in newborns with and without sepsis.Data were analyzed using Review Manager.The Cochran–Mantel–Haenszel test was used to calculate odds ratios with 95%confidence intervals.Heterogeneity was tested using the I2 index.Results From a total of 9428 possibly relevant articles,33 qualified for inclusion in this systematic review.According to the STrengthening the REporting of Genetic Association Studies,23 studies were found to be of moderate quality,while 10 were of low quality.The results showed an association of the mannose-binding lectin(MBL)exon 1 genetic polymorphism with the risk of culture-proven sepsis.Toll-like receptor(TLR)4 rs4986791 genotype distribution suggests its association with the increased risk of culture-proven sepsis.The certainty of evidence per GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)varied from very low to low.Publication bias was not detected.Conclusions Out of the 11 investigated single-nucleotide polymorphisms,this meta-analysis found a possible association between the risk for culture-proven sepsis and MBL exon 1 and TLR4 rs4986791 polymorphisms.There is an evident need for larger well-designed,multicentric observational studies investigating inflammatory gene polymorphisms in neonatal sepsis.