الفهرس 
Neonatal sepsisOnly 14 pages are availabe for public view
 |  | from | 130 |  |  |
| | | from | 130 | | |
Abstract
The study was conducted on 101neonates with sepsis (68 male and 33
female). The diagnosis depends on determination of value of sepsis score
according to this value sepsis work up was done the sepsis screen include the
following laboratory investigations:-
i. Total leukocyte count < 5000/mm3
ii. Band cell count ≥ 20%
iii. Micro ESR ≥ 15 mm/ 1st hour
iv. C-reactive protein > 6 mg/dL
v. Absolute neutrophil count <1500/mm3
Sepsis screen is considered positive if two of these are positive. Patients
were evaluated according to the estimated neonatal sepsis score as follow:-
Score1= risk of infection, score 2= need septic work up to exclude, score 3 or
more= investigate and treat.
Early onset sepsis occur within 72 hours after birth. In this category there
were 43 patients (27 term; 21 male and 6 females and 16 preterm; 9 male and 7
female). Late onset sepsis occur after the 72 hours of birth. In this category
there were 58 patients (23 term; 17 male, 6 female and 35 preterm; 21 male and
14 female).
In the current study there were 51 (50.5%) with birth weight less than 2.5
KG and 50 (49.5%) patients with birth weight more than 2.5KG.
There were 11(10.9%) very low birth weight (VLBW) patients (6 male
and 5 female) and 40 (39.6%) patients were low birth weight (LBW) patients
(25 male and 15 female).
There were 10 (9.9%) very low birth weight (VLBW) preterm patients (5
male and 5 female); and one (0.9%) very low birth weight (VLBW) term male
patient.
Summary & conclusions
- 87 -
Of 40 (39.6%) low birth weight (LBW) patients there were 31 preterm
patients (18 male and 13 female) and 9 (8.9%) term patients (7 male and 2
female).
There were 33 patients underwent blood culture and sensitivity tests.
Neonatal sepsis patients who give blood culture positive tests were 23 (15 male
and 8 female). There were 13 patients with Gram positive septicemia (9 male; 2
preterm and 7 full term, 4 female; 2 preterm and 2 full term).
There were 10 patients with Gram negative septicemia (6 male; 2 preterm
and 4 full term and 4 female; 2 preterm and 2 full term). There were 10 patients
with early onset sepsis (EOS)(8 male; 1 preterm, 7 full term and 2 female; 1
preterm, 1 full term) and 13 patients with late onset sepsis (LOS) (7 male; 3
preterm, 4 full term and 6 female; 3 preterm, 3 full term).
Isolated gram positive organisms were staphylococcus aureus and Group
B streptococcus. On the other hand isolated gram negative organisms were
Escherichia coli and klebsiella and enterococcus bacilli.
Risk factors of neonatal sepsis
1-Risk factors in neonatal sepsis patients
a- Maternal risk factors
The maternal risk factors statistically significant as risk factors in the
development of neonatal sepsis in the current study were:-
Socioeconomic status and premature rupture of membranes (PROM) which
carry 0.76 and 1.35 times risk for the development of sepsis respectively.
Other maternal risk factors; maternal age, educational status, parity, mode
of delivery (cesarian, vaginal, instrumental), meconium stained amniotic fluid
(MSAF), maternal fever in the third trimester two weeks before delivery,
pregnancy induced hypertension (PIH), pre eclamptic toxemia (PET)/
Summary & conclusions
- 88 -
eclampsia, foul smelling amniotic fluid antepartum hemorrhage, maternal
chronic diseases and medications show no statistical significance as risk factors
for the development of neonatal sepsis.
b- Fetal risk factors
The fetal risk factors which statistically significant as risk factors for the
development of neonatal sepsis in the current study were:-
Birth weight, Apgar score at 1 minute, gestational age, sex. They carry
1.21,1.33,1.29 and 1.29 times risk for the development of sepsis respectively.
Other fetal risk factors; Birth asphyxia and Complications during labour
show no statistical significance as risk factors for the development neonatal
sepsis. Sepsis score is significantly increased in patients group than control
group.
2- Risk factors in blood culture positive neonatal sepsis patients
a- Maternal risk factors
The maternal risk factors statistically significant as risk factors in the
development of neonatal sepsis in the current study were:-
Socioeconomic status and premature rupture of membranes (PROM).
They carry 2.5 and 1.6 times risk for the development of neonatal sepsis
respectively.
b- Fetal risk factors
There were no fetal risk factors statistically significant in the development of
neonatal sepsis in this patients group.
Sepsis score is significantly increased in patients group than control group.
Summary & conclusions
- 89 -
Clinical profile of neonatal sepsis
1- Clinical profile of neonatal sepsis patients
In the current study; the clinical signs of neonatal sepsis which show
statistical significance were:-
Respiratory distress, lethargy, poor feeding, abdominal distension,
hypothermia and cyanosis.
Other clinical signs; jaundice, apnea, vomiting, irritability and
convulsions show no statistical significance as clinical signs of neonatal sepsis
in the patients group than control group in this study.
2- Clinical profile of blood culture positive neonatal sepsis patients
The statistically significant clinical signs of neonatal sepsis in 23 blood
culture positive neonatal sepsis patients were:-
Respiratory distress, lethargy, fever, poor feeding, vomiting, abdominal
distension, hypothermia and cyanosis, convulsions.
Other clinical signs; jaundice, apnea, hypothermia and convulsions show
no statistical significance in the patients group than control group.
Summary & conclusions
- 90 -
Conclusions
High index of suspicion for diagnosis of neonatal sepsis is required;
especially in the presence of risk factors for neonatal sepsis, in babies
presenting with non specific clinical features. Neonatal sepsis score is very
useful tool for assessment of newborn more liable to develop neonatal sepsis
either early onset (EOS) or late onset neonatal sepsis (LOS). According to this
various maternal and fetal risk factors and calculated neonatal sepsis score,
neonatal sepsis can be confirmed by sepsis screening tests.
Clinical profile includes more non specific and not obvious clinical signs
for sepsis. In the current study Respiratory distress, lethargy, poor feeding,
abdominal distension, hypothermia and cyanosis were the statistically
significant clinical signs. However, other clinical signs; jaundice, apnea,
vomiting, irritability and convulsions show no statistical significance in this
study.
Recommendations
- 91 -
Recommendations
• Neonatal sepsis score is relatively most easy, rapid preliminary tool for
early detection of neonates liable to develop neonatal sepsis. Specially when
followed by sepsis screen as a confirmatory laboratory tests for overall
diagnosis of neonatal sepsis.
• According to the presence of different maternal and fetal risk factors
associated with the development of neonatal sepsis, new advanced and rapid
techniques that can detect presence of culprit microorganisms are highly
recommended ; like polymerase chain reaction (PCR) or real time
polymerase chain reaction (Real Time PCR) that detect conservative
regions of microorganisms genetic material, may be needed for early
detection and diagnosis of the presence of culprit microorganisms which
cause neonatal sepsis as soon as possible; to at least prevent fetal loss or
subsequent fetal health problems.
• Health facilities are needed to encourage safe pregnancy and delivery and
health care providers services to follow up high risk pregnancies.
• Health education programs about neonatal health problems which can
affect fetus of mothers with high risk pregnancy especially those with
premature labour (prematurity, low birth weight) and premature rupture of
membranes (PROM) that need prompt medical intervention.