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    Implementation of the Neonatal Sepsis Calculator in Early-Onset Sepsis and Maternal Chorioamnionitis. Akangire Gangaram,Simpson Elizabeth,Weiner Julie,Noel-MacDonnell Janelle,Petrikin Joshua,Sheehan Michael Advances in neonatal care : official journal of the National Association of Neonatal Nurses BACKGROUND:Utilization of the neonatal sepsis calculator published by Kaiser Permanente is rapidly increasing. This freely available online tool can be used in assessment of early-onset sepsis (EOS) in newborns 34 weeks' gestation or more based on maternal risk factors and neonatal examination. However, many hospitals lack standard guidelines for its use, leading to provider discomfort with practice change. PURPOSE:The goal of this project was to study the antibiotic use rate for EOS at a level III neonatal intensive care unit and create standardized guidelines and staff education for using the sepsis calculator. Our ultimate goal was to decrease antibiotic use for EOS in newborns 34 weeks' gestation or more. METHODS:A standard quality improvement Plan-Do-Study-Act (PDSA) model was utilized with a plan to study the problem, implement the intervention, and test again for improvement. The primary outcome of interest was a decrease in the use of antibiotics for EOS in neonates 34 weeks' gestation or more. RESULTS:Over a 4-month period, prior to sepsis calculator implementation, antibiotic use for suspected EOS was 11% and blood culture was done on 14.8% of live births. After implementation of the sepsis calculator and completion of the PDSA cycle, sepsis calculator use was greater than 95%, antibiotic use dropped significantly to 5% (P = .00069), and blood culture use dropped to 7.6% (P = .00046). IMPLICATIONS FOR PRACTICE:Staff education and systematic intervention using a PDSA model can significantly impact patient care, decreasing the administration of antibiotics to infants at risk for sepsis. IMPLICATIONS FOR RESEARCH:Future research is needed to decrease antibiotic use in premature infants less than 34 weeks' gestation with similar risk factors and clinical features.Video Abstract available at https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=34&autoPlay=true. 10.1097/ANC.0000000000000668
    Risk Factors for Neonatal Sepsis: A Retrospective Case-Control Study among Neonates Who Were Delivered by Caesarean Section at the Trauma and Specialist Hospital, Winneba, Ghana. Adatara Peter,Afaya Agani,Salia Solomon Mohammed,Afaya Richard Adongo,Kuug Anthony K,Agbinku Ethel,Agyabeng-Fandoh Eric BioMed research international The third Sustainable Development Goal (SDG) for child health, which targets ending preventable deaths of neonates and children under five years of age by 2030, may not be met without substantial reduction of neonatal sepsis-specific mortality in developing countries. This study aimed at assessing the prevalence and risk factors for neonatal sepsis among neonates who were delivered via caesarean section. A retrospective case-control study was conducted among neonates who were delivered via caesarean section at the Trauma and Specialist Hospital, Winneba, Ghana. Data collection lasted for 4 weeks. The extracted data were double-entered using Epidata software version 3.1 to address discrepancies of data entry. Descriptive statistics such as frequencies and percentages of neonatal characteristics were generated from the data. Both univariate and multivariate logistic regression were used to determine associations between neonatal sepsis and neonatal characteristics with odds ratios, 95% confidence intervals, and p values calculated using variables that showed significant association (p<0.05) in the chi-square analysis for the multivariate logistic regression. A total of 383 neonates were recruited; 67 (17.5%) had sepsis (cases). The neonatal risk factors associated with sepsis were birth weight (2=6.64, p=0.036), neonatal age (2=38.31, p<0.001), meconium passed (2=12.95, p<0.001), reason for CS (2=24.27, p<0.001), and the duration of stay on admission (2=36.69, p<0.001). Neonatal sepsis poses a serious threat to the survival of the newborn as the current study uncovered 6.0% deaths among sepsis cases. The findings of this study highlight the need for routine assessment of neonates in order to identify risk factors for neonatal sepsis and to curb the disease burden on neonatal mortality. 10.1155/2018/6153501
    Potential biomarkers for effective screening of neonatal sepsis infections: An overview. Chauhan Nidhi,Tiwari Sukirti,Jain Utkarsh Microbial pathogenesis Neonatal sepsis, a clinical disorder developed by bacterial blood stream infections (BSI) in neonates, is one of the serious global public health problems that must be addressed. More than one million of the estimated global newborn deaths per year are occurred due to severe infections. The genesis of the infection is divided into early-onset sepsis (EOS) and late-onset sepsis (LOS) of the disease. The clinical complications of neonatal sepsis may be associated with bronchopulmonary dysplasia, ductus arteriosus and necrotizing enterocolitis. The clinical diagnosis and treatment of neonatal sepsis is highly complicated. Over the past few years distinct biomarkers have been identified. Most widely used biomarkers are C-reactive protein, Procalcitonin (PCT) and Serum amyloid A (SAA). Until recently, many potential biomarkers including Cell Surface antigens and Bacterial surface antigens and genetic biomarkers are being investigated. Protein biomarkers, cytokines and chemokines are getting much interest for identification of neonatal sepsis infection. 10.1016/j.micpath.2017.03.042
    Serum Interleukin-33 as a Biomarker in Predicting Neonatal Sepsis in Premature Infants. Halil Halit,Tayman Cuneyt,Buyuktiryaki Mehmet,Okur Nilufer,Cakır Ufuk,Serkant Utku Combinatorial chemistry & high throughput screening BACKGROUND:Neonatal sepsis is considered as the most frequent cause of death in newborns. Early diagnosis is important to reduce mortality and morbidity. The rapid progression of the disease requires proper use of biomarkers specific for prompt diagnosis and intervention. OBJECTIVE:We aimed to evaluate the benefit of interleukin-33 serum levels in the diagnosis and treatment of neonatal sepsis. METHOD:We included 51 infants with neonatal sepsis as the main study group and 50 neonates without sepsis as the control group. Serum levels of interleukin-6, interleukin-33 and C-reactive protein were measured on the 1st, 3rd and 7th days of sepsis in the study group and on the 3rd postpartum day in the control group, respectively. RESULTS:Serum levels of interleukin-6, interleukin-33 and C-reactive protein were significantly higher in the first day of sepsis. Serum levels of interleukin-6, interleukin-33 and C-reactive protein decreased significantly on the 3rd and the 7th days of antibiotic treatment. We found a significant relationship between interleukin-33 and C-reactive protein and between interleukin-6 and C-reactive protein on the first day of sepsis. CONCLUSION:Serum interleukin-33 level is up-regulated in neonatal sepsis, which might be used as a novel diagnostic marker and also a useful tool to predict prognosis in early neonatal sepsis. 10.2174/1386207321666180911090656
    Efficacy of cefotaxime combined with gamma globulins on C-reactive protein and procalcitonin in neonatal sepsis. Zhang Fan Cellular and molecular biology (Noisy-le-Grand, France) C-reactive protein (CRP) is encoded by CRP or PTX1 gene and procalcitonin (PCT) is produced by the CALC-1 gene induction. Both PCT and CRP are known as valued biomarkers markers in prediction of Serious Bacterial Infections (SBI) in children. This experiment carried out to analyze the efficacy of cefotaxime combined with gamma globulins on neonatal sepsis and the effect on CRP and PCT. For this purpose, a total of 120 sepsis children were selected and randomly divided into observation and control groups. Children in the control group were treated with cefotaxime, while children in the observation group were treated with cefotaxime combined with gamma globulins. The two groups were compared in terms of the relative measures of efficacy, the total effective rate of treatment, the incidence of complications and serum CRP and PCT levels before and after treatment. The clinical measures of the observation group were all lower than those of the control group, and the total effective rate of the treatment was higher than that of the control group, while the incidence of complications was lower than that of the control group. In addition, before treatment, there was no difference in CRP and PCT between the two groups; after treatment, the above measures in the observation group were lower than those in the control group. It is concluded that Cefotaxime combined with gamma globulins in the treatment of neonatal sepsis has significant efficacy and is clinically more effective than cefotaxime monotherapy. This combination can shorten clinical symptom remission time and hospital stay, improve serum CRP and PCT levels and promote the recovery of children, worthy of promotion.
    Diagnostic Role of CD64 on Different Immune Cells in Early Diagnosis of Neonatal Sepsis. Abdel-Aleem Noha F,Sorour Ashraf S,Elkholy Yasmine S,Sabry Amira M The Egyptian journal of immunology Neonatal sepsis is an important cause of morbidity and mortality among neonates. Early diagnosis leads to better prognosis. CD64 can be used as an early marker to detect neonatal sepsis with promising results. Advances in flow cytometry have made it possible to assess its level on different white blood cells rapidly, precisely and with minimal blood. The aim of the present work was to assess the role of CD64 expressed on neutrophils, monocytes and lymphocytes in establishing diagnosis of neonatal sepsis as well as to compare its diagnostic value with CRP in diagnosis of neonatal sepsis. This study was performed on 80 neonates divided into 60 cases of neonatal sepsis (48 case of clinical sepsis & 12 cases of lab confirmed sepsis) and 20 healthy control neonates. Cases and controls were subjected to history taking, clinical examination and lab investigations in the form of CBC, CRP, CD64 expression on neutrophils, monocytes & lymphocytes and Blood culture (for cases only). Our study showed that CD64 expression on WBCs increases significantly in neonates with neonatal sepsis (P < 0.05) in comparison to controls. Results also showed that neutrophils CD 64 is the most sensitive indicator for detection of sepsis (sensitivity=95%, NPV=78.57%) at a cut off value of 0.18%, whereas CRP has shown the best specificity at a cut off value 3mg/Ml (specificity= 85%). In conclusion, neutrophil CD64 is superior to monocyte and lymphocyte CD64 and serum CRP in diagnosis of neonatal sepsis.
    Cytokine profile as diagnostic and prognostic factor in neonatal sepsis. Leal Yelda A,Álvarez-Nemegyei José,Lavadores-May Ana I,Girón-Carrillo Jorge Luis,Cedillo-Rivera Roberto,Velazquez Juan R The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians The serum levels of some cytokines can be useful in the diagnosis of neonatal sepsis; the prognostic value of a cytokine profile has not, to our knowledge, been explored in this disease. The objective of this study is to evaluate the diagnostic value of the serum levels of cytokines IL-1, -2, -4, -5, -6, -7, -8, -10, -12, -13, and -17, TNF, IFNγ, G-CSF, GM-CSF, MCP1, and MIP1β in neonates with high risk of developing sepsis. Sepsis was evaluated in 96 high-risk neonates. We assessed cytokine levels on hospital admission and during or not during sepsis. Fifty (52%) presented sepsis (26 early and 24 late). Sepsis was associated with high levels of IL-6, IL-10, G-CSF, and MCP1 and low levels of IFNγ, early sepsis with high levels of IL-6 and G-CSF, severe sepsis with high levels of IL-6 and IL-10, while deaths or sequelae was associated with low levels of IL-4, IL-12, IFNγ, and high levels of GM-CSF. IL-6 values of ≥40.1 pg/mL were associated with the development of any type of sepsis (relative risk [RR]: 1.70; 95% confidence interval [95% CI]: 1.18-2.24;  = .01), while IL-6 values of ≥44.9 pg/mL were associated with early sepsis (RR: 1.29; 95% CI: 1.29-4.56;  = .01). In neonates with high risk for the development of sepsis, there is an association between levels of IL-6, IL-10, and G-SCF and the disease development/outcome. 10.1080/14767058.2018.1449828
    Clinical Characteristic and Pathogen Spectrum of Neonatal Sepsis in Guangzhou City from June 2011 to June 2017. Guo Junfei,Luo Yasha,Wu Yongbing,Lai Weiming,Mu Xiaoping Medical science monitor : international medical journal of experimental and clinical research BACKGROUND Preterm and low birth weight (birth weight <2500 g) neonates are vulnerable to sepsis, and the causative pathogens vary in different regions and times. The objective of this study was to identify common organisms leading to neonatal sepsis and identify the characteristic of patients infected with different bacteria, which may help in the selection of antibiotics for empirical treatment. MATERIAL AND METHODS We retrospectively collected the clinical and microbiological data of neonates with culture-proven sepsis in our clinical setting from June 2011 to June 2017. The demography, composition, and distribution of the pathogens and the clinical characteristic of the cases infected with different bacteria were analyzed. RESULTS Of a total of 1048 bacteria that were isolated from patient samples, detailed clinical and microbiological data of 297 cases were available. Escherichia coli, Klebsiella pneumoniae, and coagulase-negative Staphylococcus (co-NS) were the top 3 isolated pathogens. Streptococcus agalactiae predominantly led to early-onset sepsis, while K. pneumoniae and Staphylococcus aureus mainly led to late-onset sepsis. K. pneumoniae was mainly acquired in the hospital. Leukopenia was more commonly seen than leukocytosis in our study, and patients infected with K. pneumoniae and Candida spp encountered more thrombocytopenia. CONCLUSIONS The results of our study revealed the composition of the pathogens of neonatal sepsis in our region and the clinical characteristic of sepsis caused by different bacteria; these data may help in the selection of antibiotics for empirical treatment of neonates with high risk of sepsis. 10.12659/MSM.912375
    The diagnostic accuracy of presepsin in neonatal sepsis: a meta-analysis. Bellos Ioannis,Fitrou Georgia,Pergialiotis Vasilios,Thomakos Nikolaos,Perrea Despina N,Daskalakis Georgios European journal of pediatrics There is growing evidence that presepsin is a promising biomarker in the diagnosis of sepsis in adults. The objective of our study is to investigate current evidence related to the diagnostic accuracy of presepsin in neonatal sepsis. To accomplish this, we searched the Medline (1966-2017), Scopus (2004-2017), Clinicaltrials.gov (2008-2017), EMBASE (1980-2017), Cochrane Central Register of Controlled Trials CENTRAL (1999-2017), and Google Scholar (2004-2017) databases. Eleven studies were included in the present meta-analysis, with a total number of 783 neonates. The pooled sensitivity of serum presepsin for the prediction of neonatal sepsis was 0.91 (95% CI [0.87-0.93]) and the pooled specificity was 0.91 (95% CI [0.88-0.94]). The diagnostic odds ratio was 170.28 (95% CI [51.13-567.11]) and the area under the curve (AUC) was 0.9751 (SE 0.0117). Head-to-head comparison with AUC values of C-reactive protein (0.9748 vs. 0.8580) and procalcitonin (0.9596 vs. 0.7831) revealed that presepsin was more sensitive in detecting neonatal sepsis. CONCLUSION:Current evidence support the use of presepsin in the early neonatal period in high-risk populations as its diagnostic accuracy seems to be high in detecting neonatal sepsis. What is known: • Neonatal sepsis is a leading cause of morbidity and mortality. • Current laboratory tests cannot accurately discriminate endangered neonates. What is new: • The diagnostic odds ratio of presepsin is 170.28 and the area under the curve is 0.9751. • According to our meta-analysis, presepsin is a useful protein that may help clinicians identify neonates at risk. 10.1007/s00431-018-3114-1
    Diagnostic value of neutrophil CD64 combined with CRP for neonatal sepsis: A meta-analysis. Song Yan,Chen Yuanchun,Dong Xue,Jiang Xiaohua The American journal of emergency medicine BACKGROUND:Sepsis is the leading cause of morbidity and mortality in newborns. CD64 combined with c-reactive protein (CRP) could improve the sensitivity and specificity of neonatal sepsis diagnosis, but the results were still controversial. Therefore, this meta-analysis was conducted to clarify the importance of CD64 combined with CRP in the diagnosis of neonatal sepsis. METHODS:The researches published as of December 24, 2018 were comprehensively searched in PubMed, Embase (included Embase and Medline), the Cochrane Library and Web of Science. Totally, 8 articles were included, involving 1114 objects. Statistical calculations were performed using Stata14.0 and Review Manager 5.3. RESULTS:The diagnostic accuracy of all included studies was pooled as follows: sensitivity, 0.95 (95% CI: 0.86-0.98); specificity, 0.86 (95% CI: 0.74-0.93); positive likelihood ratio (PLR), 6.8 (95% CI: 3.50-13.20); negative likelihood ratio (NLR), 0.06 (95% CI: 0.02-0.18); diagnostic odds ratio (DOR), 118.0 (95% CI: 25.00-549.00), and the area under the curve (AUC) was 0.96 (95% CI: 0.94-0.97). It was found that heterogeneity was not caused by threshold effect (P = 0.16), but the results of sensitivity (I = 87.57%) and specificity (I = 89.07%) analyses indicated significant heterogeneity between studies. CONCLUSIONS:The combined application of CD64 and CRP improved the accuracy of neonatal sepsis diagnosis. 10.1016/j.ajem.2019.05.001
    Interleukin-6 for early diagnosis of neonatal sepsis with premature rupture of the membranes: A meta-analysis. Qiu Xia,Zhang Li,Tong Yu,Qu Yi,Wang Huiqing,Mu Dezhi Medicine BACKGROUND:Premature rupture of the membranes (PROM) is the principal risk factor for neonatal sepsis. Interleukin-6 (IL-6) has been investigated for early diagnosis of neonatal sepsis, but not for diagnosis of neonatal sepsis with PROM. The objective of this study is to investigate the early diagnostic value of IL-6 for neonatal sepsis with PROM. METHODS:The literature was searched using PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wan Fang, VIP, and CBM databases until March 2018. Each study was evaluated using Quality Assessment of Diagnostic Accuracy Studies tool-2. We used a bivariate diagnostic random-effects model. RESULTS:The overall pooled sensitivity, specificity, positive likelihood rate, negative likelihood rate, diagnostic odds ratio, and area under the summary receiver operating characteristic curve were 0.85 (95% confidence interval [CI]: 0.81-0.91), 0.88 (95% CI: 0.86-0.91), 9.94 (95% CI: 4.27-23.15), 0.14 (95% CI: 0.06-0.32), 79.26 (95% CI: 23.42-268.26), and 0.9473, respectively, which showed high accuracy in diagnosing neonatal sepsis with PROM. The types of sepsis might be connected with the source of heterogeneity (P = .0351). CONCLUSION:IL-6 is therefore a sensitive and specific diagnostic marker for the early diagnosis of neonatal sepsis with PROM. 10.1097/MD.0000000000013146
    Serum Level of Antithrombin III (ATIII) Could Serve as a Prognostic Biomarker in Neonatal Sepsis. Samra Nashwa,AlGhwass Mohammed,Elgawhary Somaya,Hassan Mohammed,Bekhit Osama,Mohamed Wael,Eid Mohammed Fetal and pediatric pathology : Neonatal sepsis syndrome continues to have a high morbidity and mortality rate despite the progress in neonatal intensive care. There is no single diagnostic test which can reliably diagnose sepsis in the newborn, beside blood culture. Antithrombin III may be one promising single marker for sepsis syndrome diagnosis and prognosis. : We quantitated antithrombin III (ATIII) in neonates with sepsis syndrome and compared these levels to healthy controls. : ATIII levels were significantly lower in sepsis syndrome neonates (23.05 ± 3.66) compared to controls (35.50 ± 2.50), ( < 0.001). ROC curve for ATIII displayed area under the curve of 0.973, cutoff >30 mg/dL, a positive predictive value 90.47 and negative predictive value 96.55. : Antithrombin III is lower in sepsis syndrome neonates and may be a useful biomarker in neonatal sepsis. 10.1080/15513815.2019.1587118
    Performance of Haematological Parameters in Early Diagnosis of Clinically Suspected Neonatal Sepsis. Nabi S N,Basak A K,Kamruzzaman M,Pervez A F,Musharraf M,Sultana N,Moniruzzaman A M,Majumder B K,Mostakim M A Mymensingh medical journal : MMJ Neonatal sepsis is one of the major health problems throughout the world and major cause of morbidity and mortality in developing countries. Positive blood culture considers the gold standard for confirmation of neonatal sepsis, but it does not provide rapid diagnosis. So this study was designed to find out the performance of haematological parameters in early diagnosis of neonatal sepsis. The objective of the study was to evaluate the performance of haematological parameters individually and in combination in early diagnosis of neonatal sepsis. It was a cross-sectional study conducted at neonatal ward, SCANU and obstetric ward of Rangpur Medical College Hospital from January 2014 to December 2015. A total of 70 neonates clinically suspected to have features of sepsis were included in this study. Another 70 healthy term neonates were included in the study as reference group. Blood sample were obtained to estimate TLC, ANC, immature neutrophil count, degenerative changes in PMNs, platelet count, I/T and I/M ratio. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the individual test and tests combination were calculated. Among the haematological parameters, performance of combined tests had high sensitivity, specificity, with PPV and NPV. Among the individual tests I/T and I/M ratio had high sensitivity (95%), specificity (85%, 90%), PPV (90%, 75%) and NPV (90%). There were 22 out of 70 neonates (31.42%) who had culture proven sepsis. Among 22 culture proven sepsis most commonly found organism were Escherichia Coli 12(54.5%) followed by Klebsiella 3(13.63%), Proteus 3(13.63%), Staphylococcus aureus 2(9.9%) and Salmonella 2(9.9%). There is no ideal test for diagnosis of early diagnosis of neonatal sepsis haematological parameters is useful adjunct test in identifying clinically suspected neonatal sepsis.
    Evaluate the diagnosis of neonatal sepsis by measuring interleukins: A systematic review. Boskabadi Hassan,Zakerihamidi Maryam Pediatrics and neonatology Neonatal sepsis is a dangerous and common disease among infants which is associated with high morbidity and mortality. Interleukins may be helpful for diagnosis of neonatal sepsis. Therefore, this study is conducted to investigate the role of interleukins in the diagnosis of neonatal sepsis. In this study, databases including PubMed, Cochrane Library, ISI and Google Scholar were searched up to 2016. Keywords were: Sepsis, neonatal, interleukins, prediction and diagnosis. Study inclusion criteria were: Articles about the relationship between the diagnosis of neonatal sepsis and interleukins; studies on babies; English and Persian articles and enough information from test results. Articles that had focused on adult sepsis or had used other markers except ILs or just their abstracts were available were excluded from the study. Of 100 searched studies, eventually, 16 articles were considered including 12 prospective studies, 3 cross-sectional studies and 1 retrospective study. IL6 has been studied more than other interleukins (50% of articles). ILs 6, 8 and 10 are among the initial markers of neonatal sepsis diagnosis. IL6 above 68 pg/ml had 85% sensitivity and 80% specificity, IL8 above 269.51 pg/ml had 80% sensitivity and 50% specificity, IL10 above 27 pg/ml had 60% sensitivity and 87% specificity and combined interleukins above 186.83 pg/ml had 75.63% sensitivity and 71.49% specificity in sepsis diagnosis. Interleukins can be helpful in the diagnosis of neonatal sepsis based on the results of this study. IL6 had the most sensitivity and IL10 had the most specificity for diagnosis of sepsis. 10.1016/j.pedneo.2017.10.004
    The combination of procalcitonin and C-reactive protein or presepsin alone improves the accuracy of diagnosis of neonatal sepsis: a meta-analysis and systematic review. Ruan Lin,Chen Guan-Yu,Liu Zhen,Zhao Yun,Xu Guang-Yu,Li Shu-Fang,Li Chun-Ni,Chen Lin-Shan,Tao Zheng Critical care (London, England) BACKGROUND:Sepsis is an important cause of neonatal morbidity and mortality; therefore, the early diagnosis of neonatal sepsis is essential. METHOD:Our aim was to compare the diagnostic accuracy of procalcitonin (PCT), C-reactive protein (CRP), procalcitonin combined with C-reactive protein (PCT + CRP) and presepsin in the diagnosis of neonatal sepsis. We searched seven databases to identify studies that met the inclusion criteria. Two independent reviewers performed data extraction. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under curve (AUC), and corresponding 95% credible interval (95% CI) were calculated by true positive (TP), false positive (FP), false negative (FN), and true negative (TN) classification using a bivariate regression model in STATA 14.0 software. The pooled sensitivity, specificity, PLR, NLR, DOR, AUC, and corresponding 95% CI were the primary outcomes. Secondary outcomes included the sensitivity and specificity in multiple subgroup analyses. RESULTS:A total of 28 studies enrolling 2661 patients were included in our meta-analysis. The pooled sensitivity of CRP (0.71 (0.63, 0.78)) was weaker than that of PCT (0.85 (0.79, 0.89)), PCT + CRP (0.91 (0.84, 0.95)) and presepsin (0.94 (0.80, 0.99)) and the pooled NLR of presepsin (0.06 (0.02, 0.23)) and PCT + CRP (0.10 (0.05, 0.19)) were less than CRP (0.33 (0.26, 0.42)), and the AUC for presepsin (0.99 (0.98, 1.00)) was greater than PCT + CRP (0.96 (0.93, 0.97)), CRP (0.85 (0.82, 0.88)) and PCT (0.91 (0.89, 0.94)). The results of the subgroup analysis showed that 0.5-2 ng/mL may be the appropriate cutoff interval for PCT. A cut-off value > 10 mg/L for CRP had high sensitivity and specificity. CONCLUSIONS:The combination of PCT and CRP or presepsin alone improves the accuracy of diagnosis of neonatal sepsis. However, further studies are required to confirm these findings. 10.1186/s13054-018-2236-1
    The value of delta neutrophil index in neonatal sepsis diagnosis, follow-up and mortality prediction. Celik Istemi Han,Arifoglu Ilter,Arslan Zehra,Aksu Gonul,Bas Ahmet Yagmur,Demirel Nihal Early human development BACKGROUND:The complete blood cell count (CBC) and peripheral blood smear were the most commonly ordered tests for the diagnosis of neonatal sepsis. Delta neutrophil index (DNI) shows leucocyte differentiation and calculated while CBC is performed. AIMS:We aimed to evaluate the value of DNI in neonatal sepsis. STUDY DESIGN:DNI was measured with Siemens Advia 2120 and 2120i devices. DNI was calculated as (neutrophil and eosinophil count in myeloperoxidase channel)-(polymorphonuclear leucocyte count in nuclear lobularity channel). RESULTS:Study population included 141 and 87 neonates in sepsis (110 proven, 31 clinical) and control groups. Demographic characters were similar between groups. Proven sepsis group had lower birthweight and higher late-onset sepsis rate than clinical sepsis and control groups. Median DNI (16.3 vs 1,4) and CRP (6.8 vs 0,03 mg/dl) were significantly higher in sepsis group. Proven sepsis group had significantly higher DNI level than clinical sepsis group (20.8 vs 9.1). Cut-off level of DNI was 4.6 with 85% sensitivity and 80% specificity. Cut-off level of CRP was 0.58 mg/dl with 81% sensitivity and 82% specificity. Combination of DNI and CRP gave 98% sensitivity and 76% specificity. Mortality rate in sepsis group was 39%. Median DNI level in patients with mortality was significantly higher (30.1 vs 9.6). Cut-off level of DNI for mortality prediction was 16.1 with 75% sensitivity and 65% specificity. Follow-up levels of DNI was significantly decreased in 6-10 days to normal levels (16.3 to 4.2). CONCLUSIONS:DNI was found to be useful in the diagnose, follow-up and mortality prediction of neonatal sepsis without extra blood to CBC. 10.1016/j.earlhumdev.2019.02.003
    Accuracy of presepsin in neonatal sepsis: systematic review and meta-analysis. Parri Niccolò,Trippella Giulia,Lisi Catiuscia,De Martino Maurizio,Galli Luisa,Chiappini Elena Expert review of anti-infective therapy INTRODUCTION:Neonatal sepsis represents a major cause of morbidity and mortality in neonates. No diagnostic test has been demonstrated to be sufficiently accurate to confirm or exclude neonatal sepsis. This study aimed to evaluate the diagnostic accuracy of presepsin (P-SEP) for neonatal sepsis. Areas covered: A systematic review of literature was performed on Medline and EMBASE. A meta-analysis was performed to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic of P-SEP for neonatal sepsis. Eight studies were included, involving 636 neonates. Pooled sensitivity and specificity were 0.90 and 0.90, respectively. The pooled DOR was 120.94, and the Area Under Curve (AUC) was 0.968, indicating a high level of diagnostic accuracy. Using cut-off values <600 ng/L, sensitivity reached 0.93, with a specificity of 0.81 and AUC 0.8195, while using a threshold >600 ng/L, sensitivity was 0.87 and specificity 0.97, with higher diagnostic accuracy (AUC 0.976). Significant heterogeneity was found between studies. Expert commentary: Diagnostic accuracy of P-SEP resulted high in detecting neonatal sepsis. Even though it cannot be recommended as a single diagnostic test, P-SEP could be a helpful and valuable biomarker in neonates with suspected sepsis. 10.1080/14787210.2019.1584037
    Predictors of early-onset neonatal sepsis or death among newborns born at <32 weeks of gestation. Palatnik Anna,Liu Lilly Y,Lee Andy,Yee Lynn M Journal of perinatology : official journal of the California Perinatal Association OBJECTIVE:To develop a predictive model for early-onset neonatal sepsis or death among infants born at less than 32 weeks of gestation. STUDY DESIGN:This was a case-control study of all deliveries <32 weeks between 2011 and 2015 in a single tertiary care center. Cases were defined as neonates diagnosed with early-onset sepsis based on a blood or cerebrospinal fluid culture or neonates who expired during the first week of life. Controls consisted of neonates without these outcomes. Variables previously identified to be associated with neonatal sepsis or death were abstracted from the medical record. Bivariable analyses and multivariable logistic regression were used to determine independent risk factors for early-onset neonatal sepsis or death. An ROC curve was created and AUC calculated to estimate the predictive capacity of these associations. RESULTS:Of 779 eligible neonates, early-onset neonatal sepsis or death occurred in 73 (9.4%). In bivariable analyses, mothers whose neonates were diagnosed with early-onset sepsis or death were more likely to be obese, have an intrapartum fever, and have meconium-stained amniotic fluid, and were less likely to have received betamethasone or antepartum/intrapartum antibiotics. Gestational age at delivery and birth weight was significantly lower among neonates diagnosed with neonatal sepsis or death. In multivariable analyses, factors remaining independently associated with neonatal sepsis or death were earlier gestational age at the time of delivery (specifically <28 weeks), intrapartum fever, presence of meconium-stained amniotic fluid, and lower birth weight. The AUC for this regression was 0.81 (95% confidence interval 0.77-0.83). CONCLUSION:Earlier gestational age at the time of delivery, intrapartum fever, meconium, and lower birth weight are independently associated with early-onset neonatal sepsis or death among deliveries occurring at <32 weeks of gestation; these factors can be used to create a model with fair predictive capability. 10.1038/s41372-019-0395-9
    Neonatal Sepsis: Treatment of Neonatal Sepsis in Multidrug-Resistant (MDR) Infections: Part 2. Dudeja Sankalp Indian journal of pediatrics Sepsis is one of the major causes of neonatal deaths in India and worldwide. Pathogens encountered in neonatal sepsis vary worldwide; reports from developing countries more commonly show Gram negative organisms, most common being Acinetobacter spp., Klebsiella spp. and Escherichia coli. Recent studies show that the incidence of antimicrobial resistance, to third generation cephalosporins and carbapenems, has been on a rise. Because of widespread antimicrobial resistance, 'Higher' or 'Reserve' antibiotics are increasingly being used as first/second line antibiotics. In the past decade, there has been a resurgence in the use of colistin as a result of Extended-spectrum β-lactamase (ESBL)- producing Enterobacteriaceae and carbapenem resistant Enterobacteriaceae (CRE), which retain susceptibility only to colistin. The increasing burden of drug resistant Gram negative organisms, particularly Acinetobacter spp., Klebsiella spp., and E. coli might pose a formidable threat in coming years. 10.1007/s12098-019-03152-7
    C-reactive Protein as a Screening Biomarker in Neonatal Sepsis. Khan Faisal Journal of the College of Physicians and Surgeons--Pakistan : JCPSP OBJECTIVE:To measure validity of C-reactive protein (CRP) as screening test for neonatal sepsis (NS) and compare its screening validity between early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS). STUDY DESIGN:Cross-sectional study Place and Duration of Study: Neonatal Unit, Town Children Hospital, Peshawar, Khyber Pukhtunkhawa, from August 2016 to February 2017. METHODOLOGY:A total of 385 neonates from age 0 to 28 days with clinical features of neonatal sepsis were sampled using consecutive sampling technique. Two groups were identified, i.e. early onset neonatal sepsis (age <72 hours) and late onset neonatal sepsis (age >72 hours). Each neonate was sampled for blood culture and C-reactive protein (CRP). Diagnosis of neonatal sepsis was established through a positive blood culture. Data was analysed using SPSS V 25.0. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of CRP was measured and compared in each group. RESULTS:Analysis showed a low validity of CRP as screening test in neonatal sepsis (Sensitivity=35.525%, specificity=58.0%, PPV=85% and NPV=11.83%). Initial screening test validity of CRP was low in EONS (sensitivity=17.16%, specificity=58.33%, PPV=72.72% and NPV=9.81%) compared to LONS (sensitivity=77.45%, specificity=57.14%, PPV=92.94% and NPV=25.80) Conclusion: CRP as a screening test has low screening validity in early onset neonatal sepsis compared to late onset sepsis. 10.29271/jcpsp.2019.10.951
    Validity of biomarkers in screening for neonatal sepsis - A single center -hospital based study. Rashwan Nagwan I,Hassan Mohammed H,Mohey El-Deen Zeinab M,Ahmed Ahmed El-Abd Pediatrics and neonatology BACKGROUND:The diagnosis of neonatal sepsis still considered to be a challenge for both clinicians and the laboratory due to the non-specific clinical presentations. The present study aimed to compare and assess the diagnostic & prognostic values of C-reactive protein (CRP), high sensitivity CRP (hsCRP), presepsin, interleukin-6 (IL-6) and procalcitonin (PCT) in neonatal sepsis separately and in combination. METHODS:This hospital-based cross-sectional study has been conducted on 168 neonates recruited from the neonatal intensive care unit (NICU) of Qena University Hospitals, Upper Egypt. Measurements of CRP using latex agglutination test, hsCRP, presepsin, IL6 and PCT assays using commercially available ELISA assay kits were done to all included neonates. RESULTS:There were significantly higher serum levels of CRP among late onset versus early onset sepsis group with significantly higher serum levels of hsCRP and presepsin among early onset compared with the late onset sepsis group (p < 0.05 for all). There were significantly higher hsCRP, presepsin and PCT serum levels in proven versus probable sepsis group (p < 0.05 for all). Significantly higher serum levels of presepsin and PCT were noted among survivors versus non survivors sepsis group (p < 0.05 for all). The cutoff value of the serum level of CRP >6 mg/dl showed lower sensitivity and specificity than that of hsCRP at cutoff >140 ng/ml in diagnosing neonatal sepsis. The cutoff value of presepsin >200 ng/ml showed equal sensitivity and specificity to IL-6 at cutoff >22 pg/ml. The cutoff value of PCT at > 389 pg/ml showed sensitivity and specificity approximate to that of hsCRP. CONCLUSIONS:CRP could be a helpful prognostic marker in late onset neonatal sepsis. hsCRP and PCT have higher diagnostic accuracy in neonatal sepsis in comparison to other studied markers. Both IL-6 and presepsin have equal diagnostic utility in neonatal sepsis, but presepsin could be helpful diagnostic marker in early onset neonatal sepsis. 10.1016/j.pedneo.2018.05.001
    A meta-analysis of interleukin-6 as a valid and accurate index in diagnosing early neonatal sepsis. Sun Bo,Liang Lian-Fang,Li Jie,Yang Dan,Zhao Xiao-Bing,Zhang Ke-Gang International wound journal We aimed to systematically assess the overall value of interleukin 6 (IL-6) in diagnosing neonates with sepsis. A systematic literature search was conducted using the following electronic databases: PubMed, Embase, and Cochrane, to identify eligible studies through the index words updated till November 2018. Cross-sectional studies, as well as prospective cohort studies, were included in the above-mentioned group of eligible studies. We also searched the literature sources that had a link to the present study, which were further assessed by heterogeneity through the use of a proper-effects model to calculate pooled weighted specificity, sensitivity, and diagnostic odds ratio (DOR). We also conducted summary receiver operating characteristic (SROC) analyses for neonatal sepsis. In the present meta-analysis, there were 31 studies exploring IL-6 for the diagnostic accuracy of neonatal sepsis. The global specificity and sensitivity of IL-6 for neonatal sepsis were as follows: 88% (95% confidence interval [CI]: 83%-92%) and 82% (95% CI: 77%-86%), respectively. The global positive and negative likelihood ratio of IL-6 in diagnosing neonatal sepsis were 7.03 (95% CI: 4.81-10.26) and 0.20 (95% CI: 0.15-0.26), respectively. The global DOR was 29.54 (95%CI: 18.56-47.04) of IL-6. In addition, the area under the SROC was high for IL-6 (AUC = 0.92; 95% CI: 0.89-0.94). In this study, we performed a systematic review and meta-analysis to assess the diagnostic accuracy studies of IL-6 in diagnosing neonatal sepsis. Our results suggested that IL-6 is a valid and accurate index in diagnosing early neonatal sepsis, but it still needs to be combined with other laboratory tests and specific clinical manifestations. 10.1111/iwj.13079
    Efficacy of zinc supplementation for neonatal sepsis: a systematic review and meta-analysis. Tang Zhijun,Wei Zonghui,Wen Fei,Wu Yongdei The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Zinc supplementation has some potential in treating neonatal sepsis. We conduct a systematic review and meta-analysis to explore the efficacy of zinc supplementation for neonatal sepsis. PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases are systematically searched. Randomized controlled trials (RCTs) assessing the efficacy of zinc supplementation in neonatal sepsis are included. Two investigators independently search articles, extract the data, and assessed the quality of included studies. Meta-analysis is performed using the random-effect model. Four RCTs involving 986 patients are included in the meta-analysis. Overall, compared with control intervention in neonatal sepsis, zinc supplementation is able to significantly reduce mortality rate (risk ratio (RR) = 0.48; 95% confidence intervals (CIs) = 0.25-0.94;  = .03) and improve serum zinc (mean difference (MD) = 81.97; 95% CI = 34.57-129.37;  = .0007), but has no remarkable influence on hospital stay (MD = -4.51; 95% CI = -15.08 to 6.05;  = .40) and the number of expired patients (RR = 0.63; 95% CI = 0.24-1.65;  = .35). Zinc supplementation may significantly reduce mortality rate and improve serum zinc in neonatal sepsis, but has no substantial influence on hospital stay and the number of expired patients. 10.1080/14767058.2017.1402001
    Red cell distribution width and its association with mortality in neonatal sepsis. Martin Snehal L,Desai Saumil,Nanavati Ruchi,Colah Roshan B,Ghosh Kanjaksha,Mukherjee Malay B The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians OBJECTIVE:Neonatal sepsis is a major cause of mortality in the developing countries. However, with current severity scores and laboratory parameters, predicting outcomes of neonatal sepsis is a serious challenge. Red cell distribution width (RDW) is a readily available pragmatic means to predict outcomes of various comorbidities in adults and children, without causing any additional blood loss. However, its utility in neonates remains unexplored. Hence, the objective of the present study was to evaluate the association of RDW with neonatal sepsis and its role as a predictive marker for mortality. METHODS:This Prospective observational study was carried out in a Level IIIB NICU for a period of 3 years. It involved comparison of RDW values of septic neonates with those of controls (matched for gestational age and birth weight) with an equal allocation ratio. A total of 251 septic neonates along with 251 controls >28 weeks of gestational age were enrolled. The RDW was derived from complete blood count done within first 6 hours of life. After arranging the RDW (median; interquartile range (IQR)), the values were categorized as those above the 50th percentile i.e. ≥20% and those below the 50th percentile i.e. <20%. The cumulative survival rates of the above two groups were assessed using the Kaplan-Meier curve and the log rank test. RESULTS:RDW levels were significantly higher among the neonatal sepsis cases (19.90%) as compared to the controls (18.90%) with a p value of < .001. RDW was significantly higher amongst the nonsurvivors than survivors (p < .003). Kaplan-Meier curve showed that septic neonates having RDW values ≥20% had significantly increased mortality (p < .02) with a hazard ratio of 0.5. CONCLUSIONS:High RDW is associated with neonatal sepsis and is an independent outcome predictor for mortality associated with neonatal sepsis. 10.1080/14767058.2017.1421932
    Comparison between presepsin and procalcitonin in early diagnosis of neonatal sepsis. Iskandar Agustin,Arthamin Maimun Z,Indriana Kristin,Anshory Muhammad,Hur Mina,Di Somma Salvatore, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Neonatal sepsis remains worldwide one of the leading causes of morbidity and mortality in both term and preterm infants. Lower mortality rates are related to timely diagnostic evaluation and prompt initiation of empiric antibiotic therapy. Blood culture, as gold standard examination for sepsis, has several limitations for early diagnosis, so that sepsis biomarkers could play an important role in this regard. This study was aimed to compare the value of the two biomarkers presepsin and procalcitonin in early diagnosis of neonatal sepsis. This was a prospective cross-sectional study performed in Saiful Anwar General Hospital Malang, Indonesia, in 51 neonates that fulfill the criteria of systemic inflammatory response syndrome (SIRS) with blood culture as diagnostic gold standard for sepsis. At reviewer operating characteristic (ROC) curve analyses, using a presepsin cutoff of 706.5 pg/mL, the obtained area under the curve (AUCs) were sensitivity = 85.7%, specificity = 68.8%, positive predictive value = 85.7%, negative predictive value = 68.8%, positive likelihood ratio = 2.75, negative likelihood ratio = 0.21, and accuracy = 80.4%. On the other hand, with a procalcitonin cutoff value of 161.33 pg/mL the obtained AUCs showed: sensitivity = 68.6%, specificity = 62.5%, positive predictive value = 80%, negative predictive value = 47.6%, positive likelihood ratio = 1.83, the odds ratio negative = 0.5, and accuracy = 66.7%. In early diagnosis of neonatal sepsis, compared with procalcitonin, presepsin seems to provide better early diagnostic value with consequent possible faster therapeutical decision making and possible positive impact on outcome of neonates. 10.1080/14767058.2018.1475643
    Study of Risk Factors, Causative Organisms & Their Sensitivity Pattern in Neonatal Sepsis in a Community Based Tertiary Level Hospital. Quddus A R,Islam M N,Uddin M B,Mahmud A A,Badruzzaman M,Saha S K,Sattar S,Afreen K F Mymensingh medical journal : MMJ Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. The type and pattern of organisms that cause neonatal sepsis changes over time and vary from one hospital to another hospital, even in the same country. In addition the causative organisms have developed increased drug resistance for the last two decades. Maternal, neonatal and environmental risk factors have contributed for the development of sepsis. To study the risk factors, causative organism and bacterial sensitivity pattern in cases of neonatal sepsis. This cross-sectional study was conducted over a period of six months. The study included 100 patients admitted at the neonatal ward of Department of Pediatrics, Community Based Medical College Bangladesh, Mymensingh, Bangladesh. Blood samples for culture were taken aseptically before starting antibiotic therapy. Microorganisms were isolated and identified by standard microbiological processes and antimicrobial sensitivity patterns were performed against amikacin, gentamicin, ceftriaxone, ciprofloxacin and ceftazidime. The factors which carried a significant risk for development of neonatal sepsis were low birth weight, preterm neonates, meconium stained liquor and prolonged rupture of membrane (>18 hours). Gram negative organisms predominated (68.8%) with Escherichia coli (33.3%) being the commonest. The gram negative bacteria which were isolated sensitive to amikacin, gentamicin and ceftriaxone. The organisms also relatively more sensitive to ciprofloxacin and highly sensitive to ceftazidime. The Gram positive bacteria showed sensitivity against only the antibiotic Ceftriaxone and Ciprofloxacin. The overall mortality was 9%. The outcome of the study will contribute to preventing and treating neonatal sepsis in the hospital.
    Predictors of mortality in outborns with neonatal sepsis: A prospective observational study. Meshram Rajkumar Motiram,Gajimwar Vishal S,Bhongade Swapnil D The Nigerian postgraduate medical journal Background:Neonatal sepsis-related mortalities are the outcome of a complex interaction of maternal-foetal colonisation, transplacental immunity and physical and cellular defence mechanisms of neonates. Objective:The objective of this study was to evaluate the risk factors of mortality in outborn neonatal sepsis. Materials and Methods:A 1-year prospective observational study was undertaken at a tertiary care centre. All referred neonates with maternal and neonatal risk factors of sepsis were enrolled. Blood culture, sepsis screen and other relevant investigations were performed. Results:The mortality rate of neonatal sepsis among outborns was 38.24%. The common presentations of these neonates were respiratory distress, lethargy and hypothermia. On univariate analysis, significant risk factors for mortality included male sex (P = 0.05), weight on admission <1500 g (P < 0.001), hypothermia (P = 0.003), respiratory distress (P = 0.04), cyanosis (P = 0.001), convulsions (P = 0.02), prolonged capillary refill time (P < 0.001), thrombocytopenia (P < 0.001), abnormal radiological finding (P = 0.01), cerebrospinal fluid cellularity (P = 0.002) and positive C-reactive protein (P < 0.001). Maternal factors such as hypertension in pregnancy (P = 0.001) and antepartum haemorrhage (P = 0.03) were associated with statistically significant mortality. Gestational age (odds ratio [OR]: 0.49, confidence interval [CI]: 0.26-0.90, P = 0.02), weight on admission (OR: 1.57, CI: 1.08-2.27, P = 0.01), age at admission (OR: 0.89, CI: 0.78-0.99, P = 0.04), distance travelled with neonate (OR: 1.01, CI: 1.00-1.01, P = 0.003), duration of hospital stay (OR: 0.69, CI: 0.63-0.74, P < 0.001), hypothermia (OR: 1.87, CI: 1.01-3.42, P = 0.04), convulsion (OR: 2.88, CI: 1.33-6.20, P = 0.007), cyanosis (OR: 2.39, CI: 1.07-5.35, P = 0.03) and prolonged capillary refill time (OR: 3.34, CI: 1.78-6.24, P < 0.001) were the independent predictors of mortality in neonatal sepsis. Conclusion:Gestational age; birth weight; long distance travelled with neonate and presentation with hypothermia, cyanosis, convulsions and prolonged capillary refill time were the independent risk factors for mortality in neonatal sepsis among outborns. 10.4103/npmj.npmj_91_19
    Diagnostic value of mean platelet volume for neonatal sepsis: A systematic review and meta-analysis. Wang Jingjing,Wang Zhen,Zhang Min,Lou Zhenshuai,Deng Jiaxiang,Li Qian Medicine BACKGROUND:An increasing number of studies in recent years have identified mean platelet volume (MPV) as a predictive marker for neonatal sepsis. However, most of these studies focused on single regions, and therefore, the findings remain inconclusive. We, in this study, aimed to evaluate the potential of MPV as a biological indicator of neonatal sepsis through a systematic review and meta-analysis. METHODS:We searched PubMed, the Cochrane Library, Embase, and WanFang database for articles on MPV and neonatal sepsis, published from January 1, 1990 to December 31, 2018. We included 11 studies on 932 neonates with sepsis in this meta-analysis. RESULTS:The overall meta-analysis showed that MPV was significantly higher in patients with neonatal sepsis compared with healthy controls. Subgroup analysis revealed that the type of diagnostic criteria, analyzer, analyte, and controls used in the studies affected the difference in MPV between patients and healthy controls. CONCLUSION:MPV was significantly higher in the neonatal sepsis group compared to the control group. Therefore, in clinical practice, MPV could be used as an indicator for the early diagnosis of neonatal sepsis. 10.1097/MD.0000000000021649
    The challenges of neonatal sepsis management. Procianoy Renato Soibelmann,Silveira Rita C Jornal de pediatria OBJECTIVES:To present current evidence on the etiology, risk factors, diagnosis, and management of early and late neonatal sepsis. SOURCE OF DATA:Non-systematic review of the Medline (PubMed), Scopus, Web of Science, Cochrane, and Google Scholar databases regarding the following terms: neonatal sepsis, early neonatal sepsis, late neonatal sepsis, empirical antibiotic therapy, sepsis calculator, vancomycin, newborn, preterm newborn. DATA SYNTHESIS:Neonatal sepsis is a frequent cause of neonatal morbidity and mortality. Its diagnosis is difficult. Continuous observation of the patient is critical to diagnostic suspicion. When neonatal sepsis is suspected, bacteriological tests should be collected. Vancomycin should not be routinely using in the empirical antibiotic regimen in late neonatal sepsis, and the main protective mechanisms against neonatal sepsis are handwashing and the use of breast milk. CONCLUSIONS:Newborns constitute a group that is more vulnerable to sepsis. Knowledge of risk factors and etiological agents allows a better approach to the newborn with sepsis. 10.1016/j.jped.2019.10.004
    Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand. Husada Dominicus,Chanthavanich Pornthep,Chotigeat Uraiwan,Sunttarattiwong Piyarat,Sirivichayakul Chukiat,Pengsaa Krisana,Chokejindachai Watcharee,Kaewkungwal Jaranit BMC infectious diseases BACKGROUND:Early diagnosis of neonatal sepsis is essential to prevent severe complications and avoid unnecessary use of antibiotics. The mortality of neonatal sepsis is over 18%in many countries. This study aimed to develop a predictive model for the diagnosis of bacterial late-onset neonatal sepsis. METHODS:A case-control study was conducted at Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Data were derived from the medical records of 52 sepsis cases and 156 non-sepsis controls. Only proven bacterial neonatal sepsis cases were included in the sepsis group. The non-sepsis group consisted of neonates without any infection. Potential predictors consisted of risk factors, clinical conditions, laboratory data, and treatment modalities. The model was developed based on multiple logistic regression analysis. RESULTS:The incidence of late proven neonatal sepsis was 1.46%. The model had 6 significant variables: poor feeding, abnormal heart rate (outside the range 100-180 x/min), abnormal temperature (outside the range 36-37.9 °C), abnormal oxygen saturation, abnormal leucocytes (according to Manroe's criteria by age), and abnormal pH (outside the range 7.27-7.45). The area below the Receiver Operating Characteristics (ROC) curve was 95.5%. The score had a sensitivity of 88.5% and specificity of 90.4%. CONCLUSION:A predictive model and a scoring system were developed for proven bacterial late-onset neonatal sepsis. This simpler tool is expected to somewhat replace microbiological culture, especially in resource-limited settings. 10.1186/s12879-020-4875-5
    Antimicrobial Sensitivity Pattern in Neonatal Sepsis in Neonatal Intensive Care Unit of Mymensingh Medical College Hospital. Amin S E,Hossain M A,Akhtaruzzaman M,Choudhury M F,Islam N,Hossain C F,Akter F,Eva E N,Nasrin K N,Islam M N Mymensingh medical journal : MMJ This cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to determine antimicrobial sensitivity pattern in neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and then septic screening along with blood culture and antimicrobial sensitivity was done. All data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 68(72.3%) were preterm and 26(23.4%) were term. There was male predominance and male female ratio was 1.9:1. Most of the patient admitted within 72 hours of birth. Most (84%) had low birth weight (<2500gm). Pre-mature onset of labour, pre-mature rupture of membrane >18 hours, vaginal route of delivery, instrumental resuscitation, pre-lacteal feeding, bottle feeding were the major perinatal risk factors in this study. Early onset sepsis (76.6%) was most prevalent in this study. Blood culture yielded positive growth in 20(21.3%) cases. Among them, Klebsiella was found in 7(35%). E. coli in 6(30%), Acinetobacter was in 3(15%), Staphylococcus aureus in 2(10%) cases. Pseudomonas and Enterobacter were found in rest 2(10%) of the cases. Gram negative bacteria were found in 18(90%) cases. Klebsiella was sensitive to Imipenem (85.7%), Colistin (85.7%) and Ciprofloxacin (77.5%). Sensitivity of E. coli was Imipenem (100%), Colistin (100%), Amikacin (66.7%), Ciprofloxacin (66.7%), Netilmicin (66.7%) and Gentamicin (50%). Acinatobecter had sensitivity to Netilmicin, Colistin, Imipenem (100%). Staphylococcus was 100% sensitive to Imipenem, Netilmicin and Vancomycin. Pseudomonas was found sensitive to Imipenem (100%), Amikacin (100%), Netilmicin (100%) and Colistin (100%). Enterobacter was found highly sensitive to Ciprofloxacin, Colistin and Imipenem. Almost all organisms were resistant to Ampicillin, Gentamicin, Cefotaxime and Ceftazidime. Based on result it is concluded that Klebsiella pneumoniae and Escherichia coli are the leading cause of neonatal sepsis in this study and most of them resistant to multiple antibiotics. Organisms found more sensitive to Imipenem, Colistin, Ciprofloxacin and Netilmicin.
    Factors associated with culture proven neonatal sepsis in the Ho municipality 2016. Aku Fortress Yayra,Akweongo Patricia,Nyarko Kofi Mensah,Mensah Lord Graceful,Amegan-Aho Kokou,Kumi Lawrence,Afari Edwin Andrew,Ameme Donne Kofi,Kenu Ernest The Pan African medical journal Introduction:Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana. Methods:a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1: 10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals. Results:out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI: 1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI: 1.06-7.96) had higher odds of developing culture proven sepsis. Conclusion:neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules. 10.11604/pamj.2020.36.281.20408
    Neonatal sepsis in low-income countries: epidemiology, diagnosis and prevention. Popescu Constantin Radu,Cavanagh Miranda M M,Tembo Bentry,Chiume Msandeni,Lufesi Norman,Goldfarb David M,Kissoon Niranjan,Lavoie Pascal M Expert review of anti-infective therapy : Sepsis accounts for up to one-third of neonatal deaths in the world each year. The World Health Organization acknowledges neonatal sepsis as a major global health concern, and that the highest burden occurs in low- and middle-income countries (LMICs). Despite major research and clinical progress in this area, we still lack accurate diagnostic tools for neonatal sepsis, complicating the management of this condition.: The purpose here is to review the latest data on the incidence, diagnosis, prevention, and management of neonatal sepsis in LMIC. We discuss the limitations of current diagnostic tests - including their lack of availability - and how this may influence global estimates of cases. We review the benefits of antenatal, intrapartum, and post-natal preventive measures. We briefly discuss the management, highlighting the emergence of antimicrobial resistance. Finally, we expose some high priority areas.: Neonatal sepsis is a challenging condition requiring a multifaceted approach to address the major diagnostic issues, but also the underlying socio-economic causes that nourish epidemic cases in LMIC. Focusing on antibiotics as a main pillar of intervention is likely to engender antimicrobial resistance, eventually hindering the appreciable gains LMICs have achieved in neonatal health outcomes. 10.1080/14787210.2020.1732818