Havinraja, P (2012) Clinical Profile of Neonatal Late Onset Sepsis in an Intramural Setup. Masters thesis, Stanley Medical College, Chennai.
|
Text
200700212havinraja.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION: Sepsis continues to be an important cause of neonatal morbidity and mortality. It is a common problem in the newborn intensive care unit (NICU) population particularly in premature neonates. National Neonatal Perinatal Database (NNPD)1 2003 has reported the incidence of neonatal mortality as 38 per 1000 intramural live births in tertiary care institutions and the incidence of sepsis was 3%. Invasive bacterial infections primarily involve the blood stream during the first month of life. That leads to meningitis, pneumonia and multiorgan dysfunction Septicemia was the commonest clinical category with an incidence of 2.1%. Meningitis was diagnosed in 0.3 per 1000 live births1. Neonatal sepsis is the common cause of neonatal mortality contributing to 23%1 of all neonatal deaths. Neonates come from clean uncontaminated inutero environment to the environment contaminated with harmful micro organism. Newborn babies especially with low birth weight and very low birth weight are immunologically immature and vulnerable to acquiring infections. Late onset sepsis comprises the majority in this population with high rate of morbidity, mortality, longer hospital stay and increased cost. Traditionally neonatologists attribute the prevalence of late onset sepsis in the NICU population to a combination of environment and host factors including immature neonatal immune system, a compromised skin barrier, the need for invasive procedures, the prolonged use of invasive life support apparatus such as endotracheal tubes and central venous catheters and prolonged hospital stay2-6. Irrational usage of antibiotics and prolonged use of empirical antibiotics make the baby prone for Neonatal necrotizing enterocolitis (NNEC) and Late onset sepsis(LOS)7. Since in early stages of LOS the signs and symptoms are subtle or absent it is mandatory to profile the LOS. OBJECTIVES OF THE STUDY: 1. To study the babies present with strong clinical evidence of sepsis with positive rapid septic screen test and positive blood culture. 2. To study the babies with strong clinical evidence of sepsis and positive rapid septic screen test. 3. To study the babies with strong clinical evidence of sepsis with negative rapid screen test and negative blood culture 4. To study the correlation between maternal factor and late onset sepsis. DISCUSSION: Neonatal sepsis is the major contributor of the neonatal mortality and there by infant mortality. The aim of our study was to know about the profile of late neonatal sepsis and assess the environmental and maternal risk factors influencing late onset sepsis. Our study was done over a period of one year from October 2010 to September 2011. Seventy four babies were included in our study. Out of 74 babies 38 babies had been admitted in the NICU since birth for preterm and low birth weight management. The remaining 35 babies were healthy at the time of delivery without any maternal risk factor, kept along the mother side, developed sepsis after 72 hours of life. In the present study, out of 74 babies 24 babies died and 50 babies were discharged and followed up in the high risk clinic. National Neonatal Perinatal Database coined the norms of early onset sepsis and late onset sepsis. But recent Journals and some text book of neonatology state that EOS may present as late as 7 days of life and LOS from 7 days of life to as late as 8-12 weeks of life. So in our study we classified the late onset sepsis into extended early onset sepsis (3 days to 7 days) and late onset sepsis (7 days to 28 days of life). Some journals have also included another category namely Late late onset sepsis(LLOS) which would be sepsis beyond the neonatal period until 12 weeks of age. In my study we have further divided the group into proven sepsis, probable sepsis and clinical sepsis for analytical purpose. Similar classification was first tried by William E Benitz et al in USA and later by Anita Sharma et al in her study. In my study population, the commonest clinical symptom were refusal of feeds (71.6%) and respiratory distress(44.4%). Richard. A.Polin et al also found that feed intolerance and apnea were the common presentation. CONCLUSION: 1. Neonatal sepsis can be classified in to extended early onset sepsis and late onset sepsis. It is further classified in to clinical, probable and proven sepsis. 2. Refusal of feed is identified as the commonest presentation of neonatal sepsis. 3. Coagulase negative staphylococcus aureus followed by klebsiella and staphylococcus aureus are the most common organisms isolated in blood culture of the septic neonates. 4. Absolute neutrophil count <1800/cmm of blood is the most sensitive and I:T ratio >2 is the most specific laboratory markers for neonatal sepsis. 5. Culture positive CSF is the best predictor for the outcome of the disease. 6. Klebsiella Pneumoniae is resistant to conventional antibiotics and highly sensitive to cefotaxime, ciprofloxacin and imipenam. 7. CONS are resistant to all the first line antibiotics and highly sensitive to vancomycin. Ciprofloxacin and erythromycin. 8. Unshared environment plays an important risk factor for late neonatal sepsis. 9. Information education and communication to hospital personnel and the mother and attender regarding neonatal sepsis is beneficial.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Clinical Profile ; Neonatal Late Onset Sepsis ; Intramural Setup. |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 16 Apr 2018 10:42 |
| Last Modified: | 16 Apr 2018 11:01 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7020 |
Actions (login required)
 |
View Item |
