Outcome Of Sepsis Evaluations In Very-Low-Birth-Weight Premature Neonates
Dr. Ramesh Bhat. Y,Associate Professor Department of Paediatrics Kasturba Medical College,Manipal University, Manipal-576104 Udupi District, Karnataka (INDIA)E-mail: firstname.lastname@example.org
Objective: We aimed to evaluate the outcome of early onset-sepsis (EOS) workups in very low birth weight (VLBW) premature neonates
Methods: Premature neonates weighing less than 1500g were evaluated for EOS. Haematological screening parameters, CRP and blood cultures were obtained in all. EOS (occurring at <72 hours of life) was the primary outcome. We analyzed the relationship between various maternal and neonatal characteristics, screening parameters, CRP and EOS.
Results: The present study included 36 premature VLBW neonates. The mean (SD) gestational age and birth weight were 31.2(2.5) weeks and 1252.9(199.9) gms, respectively. Obstetric risk factors were present in 12 (33.3%) neonates. Twenty (55.6%) neonates had EOS, 2 (5.6%) grew organisms in their blood culture and 5 (13.9%) died. EOS was slightly, but not significantly higher in neonates who were born with obstetric risk factors as compared to those who were not born without the risk factors (OR 1.18; 95%CI: 0.29-8.46; p=0.27). Choreoamnionitis, decreasing gestational age and birth weight were associated positively. Asymptomatic newborns were at a lower risk than their critically illcounterparts (33.3% Vs 62.9%; OR 0.29). The sensitivity of the haematological screening parameters and CRP varied from 10%-35%. Combination of any two parameters had a sensitivity of 40% and a negative predictive value of 50%. Neonates with EOS had a significantly longer duration of mechanical ventilation (p=0.03) and higher mortality than those without EOS (25% Vs 6.3%).
Conclusions: Blood culture proven EOS is uncommon among VLBW premature neonates, but clinical sepsis continues to be a significant problem. Infection rate in asymptomatic neonates is low. Haematological screening parameters and CRP have limited roles in distinguishing the infected neonates from the uninfected ones.