Jothi, D S (2012) Clinical Profile and Outcome Oclinical of Neonatal Sepsis in a Tertiary Care Centre, Trichy, Tamil Nadu. Masters thesis, K.A.P.V. Government Medical College, Tiruchirappalli.
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Abstract
INTRODUCTION: Neonatal septicemia refers to a clinical syndrome characterized by systemic signs and symptoms due to generalized bacterial infection with a positive blood culture in the first four weeks of life. Bacterial infections are the commonest cause of morbidity and mortality during the neonatal period. Fulminant and fatal course of infection may result from complications such as shock, disseminated intravascular coagulation and multi-system organ failure, mandating early diagnosis of this life-threatening condition for a timely treatment and a favourabIe outcome. Sepsis is the commonest cause of mortality responsible for 30-50% of the 5 million total neonatal deaths each year. The reported incidence of neonatal sepsis varies from 7.1 to 38 per 1000 live births in Asia. National Neonatal Perinatal Database (NNPD, 2002- 2003) from India has reported an incidence varying from 0.1% to 4.5%1. Sepsis to be one of the commonest causes of neonatal mortality contributing to19% of all neonatal deaths. Gram negative organisms are found to be more frequently than Gram positive organisms as evidenced by many Indian studies2,3. The clinical presentation is often subtle or nonspecific and usually mimicked by several other disorder. AIMS AND OBJECTIVES: 1. Neonatal mortality remains high in our country in spite of the decline in the infant mortality rate. One third of the neonatal mortality is reported to be due to sepsis and related illness. 2. Hence this study was planned to understand the clinical parameters, role of investigations and the outcome in neonatal sepsis. 3. To analyze the causative organisms and their sensitivity pattern. 4. To identify the perinatal risk factors in the causation and outcome of neonatal sepsis. 5. To identify modifiable risk factors in order to develop appropriate strategies to address them. 6. To identify laboratory investigations for early diagnosis of sepsis. DISCUSSION: Sepsis is the commonest cause of neonatal morbidity and mortality. It is responsible for about 30-50% of total neonatal deaths.23 Sepsis related morbidity and mortality is largely either preventable or treatable with rational antimicrobial and supportive therapy. LBW is a strong risk factor for neonatal sepsis due to multiple reasons. Unsafe delivery or unclean delivery at inappropriate place is another important predisposing factor for sepsis. Earliest clinical features of neonatal sepsis are often subtle and non specific therefore a high index of suspicion is needed for early diagnosis specially so if risk factors are also present. In the present study majority of neonates presented with refusal to feeds (91.2%) lethargy (86.4%) tachyphea (75%) and fever (50.4%) which is comparable to various other study5. In this study documented hypothermia (12%) were apnea in (10.4%), convulsions (12.8%) which is correlated well with various study.24 Male neonates were reported to be affected more with sepsis as compared to females in some studies.8,25 This is in concordance with our study as well (p < 0.05) Bias for male sex, place of study, sample including other factors may be responsible for increased number of male cases in these studies. There was statistically significant difference (p < 0.05) in sepsis cases born in the study institution (inborn) as compared to those brought from outside (out born). In inborn category (62.4%) had sepsis as compared to (37.6%) in out born group. CONCLUSION: Blood culture was positive in 50(20%) neonates. About 84% of infections were caused by gram negative organisms, Klebsiella being the commonest organism causing sepsis. For most of the gram-negative organisms, Amikacin and third generation cephalosporins were effective. The common clinical presentations are lethargy (65.8%), refusal to suck (65.8%), tachypnea (98.3%) and fever (58.3%). When clinical signs like chest retractions, grunt and Abdominal distension, bulging fontanelle were present the likelihood of proven sepsis is high. The incidence of sepsis was shown to be higher among neonates with Perinatal risk factors such as risk factors, multiple vaginal examination during labour, lowbirthweight and preterm neonates. CRP has a high negative predictive value but low positive predictive value with sensitivity and specificity of 83% and 37.2% respectively. The specificity of combinations of hematological parameters were higher than that of CRP. The positive predictive value and specificity was high when two or more tests were combined together. Neonatal septicemia is still a leading cause of mortality and morbidity in developing countries like India. It is more common among males, low birth weight and preterm neonates. It is also found to be more common among the hospital inborn neonates with spontaneous vaginal delivery. Early onset septicemia is more common compared to late onset septicemia. Gramnegative organisms are the predominant causative agents in neonatal septicemia. Infections are a major threat to the premature and low birth weight neonates with multidrug resistant microorganisms emerging as a major problem. Blood culture is still the “Gold standard” for the diagnosis of septicemia in neonates and should be done in all cases of suspected septicemia. In view of the changing spectrum of the causative agents of neonatal septicemia and their antibiotic susceptibility patterns from time to time and from one hospital to another, a positive blood culture and the antibiotic susceptibility testing of the isolates are the best guide in choosing the appropriate antimicrobial therapy in treating neonatal septicemia.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical Profile ; Outcome Oclinical ; Neonatal Sepsis ; Tertiary Care Centre ; Trichy ; Tamil Nadu |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 18 Apr 2018 06:53 |
| Last Modified: | 18 Apr 2018 06:53 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7089 |
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