Profile of Neonatal Sepsis in a Tertiary Care Centre, Chennai, Tamil Nadu

INTRODUCTION: Of the 130 million babies born every year, about 4million die in the first 4 weeks of life, the neonatal period1. Most neonatal deaths (99%) arise in low-income and middle- income countries, and about half occur at home. In poor communities, many babies who die are unnamed and unrecorded, indicating the perceived inevitability of their deaths. The three major causes of neonatal deaths worldwide are infections, including sepsis, pneumonia, tetanus, and diarrhea (36 per- cent); prematurity (28 percent); and birth asphyxia or problems related to childbirth complications. In the Institute of Child Health and Hospital for Children, which is a tertiary care centre, attached to Madras Medical College, admits approximately 4000 neonates for various causes in its extramural new born ward. The common causes of admissions were preterm care, septicemia, jaundice, birth asphyxia etc. hyaline membrane disease may coexist with bacterial pneumonia. Acidosis impairs functions of polymorph nuclear leukocytes. 4) The manifestations of infectious diseases in the newborn infant are extremely variable. In addition, the comparative immunodeficiency of the neonate not only predisposes him to infection, but also means that when infection occurs it may disseminate very rapidly, with septicemia shock and death occurring within 12 hours of the first signs of illness. This dissemination which is particularly rapid has two major implications: 1. Early diagnosis is essential. Even very trivial clinical findings that suggest infection demand full laboratory evaluation. 2. Initial therapy must be started on the basis of clinical suspicion. There is no time to wait for the laboratory results like blood culture to come back after 48 – 72 hours later. OBJECTIVES: 1. To describe the clinical presentation of community acquired sepsis in neonates admitted in the extramural ward of our hospital. 2. To analyze the causative organisms and their sensitivity pattern. 3. To identify the neonatal and the maternal risk factors in the causation and outcome of neonatal sepsis. 4. To identify modifiable risk factors in order to develop appropriate strategies to address them. 5. To identify laboratory investigations for early diagnosis of sepsis. DISCUSSION: In this study, out of 120 neonates enrolled, blood culture was positive in 25(20.8%) neonates, C-reactive protein positive in 59(49.2%) neonates, abnormal WBC counts in 56(46.6%) neonates, IT ratio > 0.2 in 39(32.5%) neonates and neutrophil toxic granules in 46(38.3%) neonates. In this study, the rate of culture positive sepsis is 20.8%. This rate ranged from 20% to 48.38% in other studies. A low blood culture isolation rate in this study might be due to several reasons, e.g. different study population, administration of antibiotics before blood collection either to This may be due to the fact that traditional birth attendants are not trained to conduct deliveries in a sterile manner. In this study, the incidence of sepsis was shown to be higher among illiterate mothers, those with premature rupture of membranes (PROM) >18 hours and vaginal examination >3 times during delivery (statistically significant). Kurien Anil Kuruvilla et al have found that multiple vaginal examinations were significantly associated with early onset sepsis. Anne Schuchat et al have also shown that among the maternal risk factors, PROM >18 hours and multiple vaginal examinations during delivery are significant risk factors. Premature rupture of membranes and multiple vaginal examinations during delivery are important for the organisms in the genital tract to gain access into the amniotic fluid to cause ascending infections. CONCLUSION: 1. Blood culture was positive in 25(20.8%) neonates. 2. About 76% of infections were caused by gram negative organisms, E coli being the commonest organism causing sepsis 3. For most of the gram-negative organisms, gentamycin and thirdgeneration cephalosporins were effective. 4. The common clinical presentations are lethargy (65.8%), refusal to suck (65.8%), tachypnea (98.3%) and fever (58.3%). 5. When clinical signs like chest retractions, grunt and bulging fontanelle were present the likelihood of proven sepsis is high. 6. The incidence of sepsis was shown to be higher among neonates with maternal such as risk factors, premature rupture of membranes (PROM) >18 hours and multiple vaginal examination during labour. 7. The occurrence of sepsis was high (69.2%) in the neonates who were not exclusively breast fed and when given home remedies. 8. CRP has a high negative predictive value but low positive predictive value with sensitivity and specificity of 88% and 61% respectively 9. The specificity of combinations of hematological parameters were higher than that of CRP