Neonatal sepsis: An old problem with new insights (original) (raw)
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Early and late markers for the detection of early-onset neonatal sepsis
Danish medical bulletin, 2008
In this study we tested how a combination of early and late paraclinic markers could predict early onset neonatal sepsis (EONS). The first 24 hours after the suspicion of EONS, we measured interleukine (IL)-6, IL-8, IL-10, IL-18, tumor necrosis factor-alpha (TNF-alpha), interferon gamma (INF-gamma), procalcitonin (PCT) and C-reactive protein (CRP) at 8-hour intervals on 123 neonates clinically suspected for EONS. The neonates were divided into two groups. The sepsis group: 1A with blood culture verified bacteraemia and 1B strongly suspected sepsis (29 patients). The no sepsis group: 2A treated with antibiotics (37 patients) and 2B not treated with antibiotics (57 patients). Combined evaluation of each of the early markers with PCT > 25 ng/ml for prediction of EONS at time 0, gave the following sensitivities and specificities: IL-6 > 250 pg/ml: 71% and 88%; IL-8 > 900 pg/ml: 50% and 88%; IL-10 > 40 pg/ml: 43% and 87%; and immature/total (I/T) ratio > 0.35: 59% and 88%....
Changing patterns of neonatal sepsis
Sri Lanka Journal of Child Health, 2009
Despite major advances in neonatology during the past few decades, many infants still develop lifethreatening infections during the first month of life. The increasing population of very low birth weight (VLBW) premature infants, who now survive due to improved neonatal care, represent the group at highest risk for neonatal infection.
Future Directions in the Evaluation and Management of Neonatal Sepsis
NeoReviews, 2012
Although sepsis is one of the important etiologies of illness in hospitalized infants, it is often difficult to determine if an infant is truly infected and, moreover, how to treat these infections. To address the first issue, researchers have begun to examine techniques to shorten the amount of time it takes to culture and identify organisms. On the clinical side, the development of biomarkers may help physicians to better identify infants who are likely ill from infection versus those infants who are unstable from other processes. The ability to distinguish between these cohorts will help to curtail excessive use of empirical antibiotics. Even if infants are determined to truly have infection on the basis of a positive culture, it is becoming more challenging to appropriately treat causative organisms, as multidrug resistance becomes more prevalent. Furthermore, it becomes more important to evaluate strategies to prevent these infections before they occur. Objectives After completing this article, readers should be able to: 1. Understand new developments in serum biomarker research. 2. Recognize the steps in identifying infectious organisms and how current research into new laboratory techniques may be able to expedite this process. 3. Understand the uses and limitations of less well-known antimicrobial agents in treating multidrug-resistant infections. 4. Understand the importance of hand hygiene and careful central catheter use in preventing neonatal infection. 5. Become familiar with recent research on the utility of nutrition, including early enteral feeding, human milk, and lactoferrin, in the prevention of infection.
Neonatal Sepsis: Current Issues
Neonatal sepsis is an entity of worldwide concern. It is peculiar in that it is not a circumscribed disease. It is a scourge both in developed and developing countries as it has been recognised as one of the greatest causes of perinatal mortality. In 2005, it was estimated that about 1.6 million neonatal deaths in developing countries were caused by neonatal infections[1]. In these countries, neonatal infections were found to cause 34 out of 1000 deaths compared to 5 out of 1000 neonatal deaths in developed countries[2]. It was found to be the sixth greatest cause of death neonates in the United States in 2011[3]. Among major causes of neonatal death are perinatal asphyxia and prematurity[1]. Despite decades of history on the subject, a definition has yet to be established for neonatal sepsis. Over the years, the definition has included the isolation of a causative microorganism (bacteria, fungi, virus) from clinical samples obtained from the baby. Loosely, it is a term used to designate a systemic condition of bacterial, viral, or fungal (yeast) origin that is associated with haemodynamic changes and other clinical manifestations and results in substantial morbidity and mortality[4]. In 2005, the International Paediatric Sepsis Consensus Conference defined sepsis as a “systemic inflammatory response syndrome (SIRS) in the presence of or as a result of suspected or proven 5infection.”[5] New born infants are predisposed to infections which lead to sepsis and the reason for this is discernible in the nature of their immune systems. The immune system of the new born is greatly devoid of several components and those which are present are largely underdeveloped[3]. This state leaves them susceptible/vulnerable to infections by a host of organisms which range from viruses, fungi, bacteria et cetera[3].
Evaluating the Near-Term Infant for Early Onset Sepsis
The Journal of Molecular Diagnostics, 2006
Although the rate of early onset sepsis in the nearterm neonate is low (one to eight of 1000 cases), the rate of mortality and morbidity is high. As a result, infants receive multiple, broad-spectrum antibiotic therapy, many for up to 7 days despite blood cultures showing no growth. Maternal intrapartum antibiotic prophylaxis and small blood volume collections from infants are cited as reasons for the lack of confidence in negative culture results. Incorporating an additional, more rapid test could facilitate a more timely diagnosis in these infants. To this end, a 16S rDNA polymerase chain reaction (PCR) assay was compared to blood culturing for use as a tool in evaluating early onset sepsis. Of 1751 neonatal intensive care unit admissions that were screened, 1233 near-term infants met inclusion criteria. Compared to culture, PCR demonstrated excellent analytical specificity (1186 of 1216, 97.5%) and negative predictive value (1186 of 1196, 99.2%); however, PCR failed to detect a significant number of culture-proven cases. These findings underscore the cautionary stance that should be taken at this time when considering the use of a molecular amplification test for diagnosing neonatal sepsis. The experience gained from this study illustrates the need for changes in sample collection and preparation techniques so as to improve analytical sensitivity of the assay.
Pediatrics, 2018
The incidence of neonatal early-onset sepsis (EOS) has declined substantially over the last 2 decades, primarily because of the implementation of evidence-based intrapartum antimicrobial therapy. However, EOS remains a serious and potentially fatal illness. Laboratory tests alone are neither sensitive nor specific enough to guide EOS management decisions. Maternal and infant clinical characteristics can help identify newborn infants who are at risk and guide the administration of empirical antibiotic therapy. The incidence of EOS, the prevalence and implications of established risk factors, the predictive value of commonly used laboratory tests, and the uncertainties in the risk/benefit balance of antibiotic exposures all vary significantly with gestational age at birth. Our purpose in this clinical report is to provide a summary of the current epidemiology of neonatal sepsis among infants born at ≥35 0/7 weeks’ gestation and a framework for the development of evidence-based approac...