Neonatal Sepsis

Dr Prakash V., Dr. R. Kishore Kumar
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Neonatal Sepsis - Introduction
Sepsis continues to be among the leading cause for neonatal deaths contributing to 33% of neonatal deaths in India(1), despite the fact that the field of neonatology has grown by leaps and bounds in the past decade. It is extremely important to arrive at an early diagnosis of sepsis to prevent morbidity and mortality. However, progress in this area has been far from satisfactory, and newer methods are being studied in the quest for a fool-proof system.
Classification of Neonatal Sepsis:
Sepsis can be classified into early onset sepsis (EOS) where clinical manifestations appear within 72 hours of birth or late onset sepsis (LOS) symptoms develop after 72 hours of life.
Risk factors associated with EOS are low birth weight (<2500 grams) or prematurity, fever in the mother with bacterial infection within 2 weeks before delivery, foul smelling and/or meconium stained liquor, rupture of membranes >24 hours, single unclean or > 3 sterile vaginal examinations, prolonged labour (total duration of 1st and 2nd stage of labour > 24 hrs) and Apgar score <4 at 1 minute.
In the Presence of Foul smelling liquor or three of the above mentioned risk factors, antibiotics to be started, for Infants with two risk factors septic screen to be done and treatment are decided based on the results (2,3)
Late onset sepsis (LOS): factors that predispose to an increased risk are low birth weight, prematurity, admission in intensive care unit, mechanical ventilation, invasive procedures, administration of parenteral fluids.

Early onset sepsis (EOS) is acquired either in-utero, or during the passage through the birth canal during delivery. Ascending infection following rupture of membranes is also an important source for EOS. Late onset sepsis by contrast (LOS) is acquired after birth from the hospital environment or from the community.
In India, unlike in the West gram negative organisms are the commonest cause for neonatal sepsis of which Klebsiella is the most common pathogen isolated among both intramural and extramural births followed by Staphylococcus aureus. (4) Hence antibiotic policies should be individualized according to institutional antibiogram characteristics.


References
Neonatal Sepsis Neonatal Sepsis 09/05/2018
Neonatal Sepsis - Clinical Features >>
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