RISK FACTORS FOR EARLY ONSET NEWBORN SEPSIS
Dr. Shanthi Ananthakrishnan*, Fr. Sarala Premkumar**
Mahatma Gandhi Medical College & Research Institute, Pondicherry.*, Mahatma Gandhi Medical College & Research Institute, Pondicherry.**
Introduction
Early onset newborn sepsis (onset of sepsis < 72 hours) is related to several perinatal factors and empirical treatment with antibiotics is started on many occasions on Asymptomatic babies when these risk factors are present. In order to optimize treatment, it is necessary for every hospital to have a rational and empiric treatment strategy. This study was undertaken to describe the pattern of early onset NB sepsis and identify the perinatal factors associated with it.
Subjects & Methods
Thirty consecutive babies admitted to the NICU with a clinical diagnosis of sepsis before 72 hours of age formed the study group. Maternal and neonatal details were obtained on a pre-designed proforma. Similar details were obtained form 60 well babies who formed the control group. Blood for culture of pathogens, total and differential leucocyte counts were done on all babies. C-reactive protein (CRP) was done on 25 babies. Chest X-rays were taken for 4 babies who were clinically suspected to have pneumonia. CRP was not quantified and a positive value was taken as evidence of sepsis. Band count was not done.
Results
  • The clinical features of sepsis observed were poor feeding (50%), jaundice (60%), respiratory distress (56.6%), abdominal distension (6.6%), irritable cry (3.3%), convulsions (3.3%), and sclerema (3.3%).
  • Blood culture grew pathogens in 12 (40%) and CRP was positive in 16 (64%). The mean TLC was 14,332. The organisms isolated were K. pneumoniae 5 (35%), coagulase negative staphylococci 3 (21.4%), pseudomonas 2 (14.2%), micrococci 1 (7.1%), AG fecalis 1 (1.7%).
  • Although not statistically significant, a higher proportion of babies whose mothers had fever and/or whose CRP was positive had a positive blood culture.
  • A significantly higher proportion of mothers with fever PROM > 12 hours were found in the septic group which also had a significantly higher proportion of babies delivered instrumentally, preterm, had meconium stained liquor, and an Apgar of < 7 at 5 minutes. The control group had a significantly higher proportion of babies delivered by LSCS.
Conclusion
In this study has shown that the perinatal factors associated with EONS are similar to that described by earlier workers. A large and focused study is necessary to determine the role of maternal fever and CRP alone as indicators for initiating empirical antibiotics in asymptomatic babies.

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Ananthakrishnan S D, Premkumar S F.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=369
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