Drug Therapy in Neonatal Sepsis

1989 ◽  
Vol 2 (1) ◽  
pp. 28-35
Author(s):  
Susan Phillips ◽  
Glenn Kaplan
Keyword(s):  
Neonatal Sepsis ◽  
Bacterial Infections ◽  
Neonatal Intensive Care ◽  
Clinical Status ◽  
Clinical Manifestations ◽  
Neonatal Morbidity ◽  
Treatment Modalities ◽  
Isolation And Identification ◽  
Technological Advances ◽  
High Risk Infants

Despite the remarkable technological advances in neonatal intensive care, bacterial infections continue to be a significant cause of neonatal morbidity and mortality. The clinical manifestations of sepsis are frequently subtle and nonspecific. Progression of the disease is rapid and mortality continues to be high. Antimicrobial therapy must be instituted as soon as possible after symptomatic and high risk infants are identified. Empiric broad spectrum antibiotic therapy is initiated to cover the most likely pathogens that are etiologic in neonatal sepsis. Pathogen specific therapy is guided by the isolation and identification of the infecting organism and its susceptibility patterns. The clinical status of the infant must be closely monitored, and basic supportive care provided to optimize the infants chance of survival. The emergence of drug resistance and adverse drug reaction profiles may further dictale which antimicrobial regimen is the safest and most effective. Unconventional therapies should be reserved for the most critically ill infants after conventional treatment has failed. Controlled trials of pharmacologic and nonpharmacologic treatment modalities for neonatal sepsis are needed to optimize the management of these infants.

Presepsin - New Marker of Sepsis Romanian Neonatal Intensive Care Unit Experience

2019 ◽  
Vol 70 (8) ◽  
pp. 3008-3013
Author(s):  
Silvia Maria Stoicescu ◽  
Ramona Mohora ◽  
Monica Luminos ◽  
Madalina Maria Merisescu ◽  
Gheorghita Jugulete ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Neonatal Intensive Care ◽  
Complete Blood Count ◽  
Clinical Manifestations ◽  
Receiver Operating Curve ◽  
Predictive Values

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.

Serum Pentraxin 3 Concentration in Neonatal Sepsis

2019 ◽  
Vol 14 (05) ◽  
pp. 219-222
Author(s):  
Fatih Battal ◽  
Özgül Emel Bulut ◽  
Şule Yıldırım ◽  
Hakan Aylanç ◽  
Nazan Kaymaz ◽  
...  
Keyword(s):  
Neonatal Sepsis ◽  
Bacterial Infections ◽  
Clinical Signs ◽  
Neonatal Morbidity ◽  
Gene Organization ◽  
Control Group ◽  
Case Group ◽  
Pentraxin 3 ◽  
Suspected Sepsis ◽  
Reactive Protein

Objective Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. Symptoms and signs of neonatal sepsis can be silent; therefore, laboratory investigation is necessary in cases of doubt or if there are risk factors. Early diagnosis is important for early intervention and treatment. The most valuable method for diagnosis is blood culture; however, false positivity due to contamination or false negativity despite ongoing fatal bacterial infections can be seen. Pentraxin 3 is a prototype of the long pentraxin family. It has some differences from C-reactive protein (CRP) in terms of gene organization and localization and production site. It is effective in the early phase of inflammation and it is detected as an early marker of sepsis in adults. The aim of this study was to investigate whether pentraxin 3 can be used as a marker in neonatal sepsis. Materials and Methods Thirty newborns with suspected sepsis with antenatal history or the presence of clinical signs of sepsis, such as hypo/hyperthermia, feed intolerance, lethargy, hypotonia, irregular cardiac rhythms, bradycardia, cyanosis, apnea, respiratory distress, or metabolic acidosis, were enrolled in the study as a case group, and 28 healthy newborns were included as a control group. Serum pentraxin 3, procalcitonin, CRP, and hemogram in the study group and serum procalcitonin and pentraxin in the control group were examined. Results Serum pentraxin 3 (pg/mL) and serum procalcitonin (ng/mL) levels were 2,273.82 ± 1,260.75 and 0.86 ± 0.52 in the case group and 957.41 ± 268.00 and 0.19 ± 0.18 in the control group (p < 0.001 for both), respectively. Conclusion The present study showed that serum pentraxin 3 levels may be a useful marker in the diagnosis of neonatal sepsis.

scholarly journals Redeterapia: um caminho da percepção à aplicabilidade por enfermeiros

2020 ◽  
Vol 10 (30) ◽  
pp. 45-53
Author(s):  
Amanda Raquel Dias Nobre ◽  
Amanda Soares ◽  
Thaynara Filgueiras Ferreira ◽  
Wellyson Souza do Nascimento ◽  
Carla Lidiane Jácome dos Santos ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Neonatal Morbidity ◽  
Neonatal Intensive Care Units ◽  
Technological Advances ◽  
Analysis Technique ◽  
Maternity Hospitals ◽  
Terapia Intensiva ◽  
High Level ◽  
Nursing Professionals

A assistência qualificada ao recém-nascido prematuro promoveu avanços científicos e tecnológicos que contribuíram para redução da morbimortalidade neonatal. O uso de redes de balanço, a redeterapia pode ajudar no controle da frequência cardíaca e respiração dos bebês, segundo as evidências. O objetivo deste estudo foi verificar a percepção de enfermeiros sobre o uso da redeterapia em recém-nascidos em unidades de cuidados intensivos neonatais. Para isso realizou-se um estudo de campo com abordagem qualitativa, realizado em duas maternidades de referência no cuidado ao recém-nascido. Fizeram parte da amostra vinte profissionais de enfermagem de nível superior do setor de Unidade de Terapia Intensiva Neonatal. A análise dos dados deu-se por técnica de análise do conteúdo proposta por Bardin emergindo duas categorias: Concepções acerca do uso da redeterapia na assistência do enfermeiro ao RNPT; Desafios assistenciais cotidianos frente ao uso da redeterapia por enfermeiros; e benefícios da redeterapia ao RNPT.Descritores: Enfermagem Neonatal, Procedimento Terapêutico, Recém-nascido Prematuro. Redeterapy: a path of perception to applicability by nursesAbstract: Qualified care for premature newborns has promoted scientific and technological advances that have contributed to reducing neonatal morbidity and mortality. The use of balance nets, redeterapia can help control the heart rate and breathing of babies, according to the evidence. The aim of this study was to verify the perception of nurses about the use of redeterapy in newborns in neonatal intensive care units. For this, a field study with a qualitative approach was carried out, carried out in two reference maternity hospitals in the care of the newborn. Twenty high-level nursing professionals from the Neonatal Intensive Care Unit sector were part of the sample. The data analysis was performed using the content analysis technique proposed by Bardin, with two categories emerging: Conceptions about the use of redeterapy in nurses' care for PTNB; Daily care challenges regarding the use of redeterapy by nurses; and benefits of PTN redeterapy.Descriptors: Neonatal Nursing, Therapeutic Procedure, Premature Newborn. Redeterapia: un camino de la percepción a la aplicabilidad por enfermerosResumen: La atención calificada para recién nacidos prematuros ha promovido avances científicos y tecnológicos que han contribuido a reducir la morbilidad y mortalidad neonatal. El uso de redes de equilibrio, redeterapia puede ayudar a controlar la frecuencia cardíaca y la respiración de los bebés, según la evidencia. El objetivo de este estudio fue verificar la percepción de las enfermeras sobre el uso de redeterapia en recién nacidos en unidades de cuidados intensivos neonatales. Para ello, se realizó un estudio de campo con un enfoque cualitativo, realizado en dos hospitales de maternidad de referencia al cuidado del recién nacido. Veinte profesionales de enfermería de alto nivel del sector de la Unidad de Cuidados Intensivos Neonatales formaron parte de la muestra. El análisis de datos se realizó utilizando la técnica de análisis de contenido propuesta por Bardin, con dos categorías emergentes: Concepciones sobre el uso de la redeterapia en la atención de enfermeras para PTNB; Desafíos de atención diaria con respecto al uso de la redeterapia por parte de las enfermeras; y beneficios de la redeterapia PTN.Descriptores: Enfermería Neonatal, Procedimiento Terapéutico, Recién Nacido Prematuro.

scholarly journals Immature to Total Neutrophil (I/T) Ratio sebagai penunjang Diagnosis Sepsis Neonatorum

2018 ◽  
Vol 16 (2) ◽  
pp. 73
Author(s):  
Bastiana Bastiana ◽  
Aryati Aryati ◽  
Yulia Iriani
Keyword(s):  
Neonatal Sepsis ◽  
Bacterial Infections ◽  
Neonatal Intensive Care ◽  
Blood Smear ◽  
Differential Count ◽  
Cross Sectional ◽  
Predictive Values ◽  
Kappa Test ◽  
Positive Rate ◽  
Cochran Test

Early diagnosis of neonatal sepsis plays an important role in the management of patients. Blood culture, currently used as thegold standard, has several limitations such as time consuming and low positive rate. For this reason, a rapid and accurate diagnosticmethod is required. Manual differential count is a practical, inexpensive method and can support the diagnosis of bacterial infections.A shift to the left in differential white count with a raised immature neutrophil count has been documented in patients with bacterialinfections. This led to the use of I/T ratio as a indicator towards bacterial infections. The aim of this study is to obtain the diagnosticvalue of I/T ratio in diagnosing neonatal sepsis. The study was a prospective and cross-sectional. The subjects were enrolled consecutively,consisting of newborn babies (from birth to 30-days old) admitted to the Neonatal Intensive Care Unit (NICU) of the Dr. SoetomoHospital, Surabaya. Forty and three samples, consisting of 13 sepsis samples and 30 nonsepsis as controls samples were examined. I/Tratio are a ratio between immature neutrophils against total neutrophils in blood smear preparation. For the determination of the whitecell differential count, a total of 100 white cells (granulocytes) were counted. I/T ratio > 0.2 showed an abnormality that suggestaninfection process occur. Blood smear evaluations were done by three (3) independent observers. The result from three (3) observerswere as follows: sensitivity and specificity of I/T ratio in the diagnosis of neonatal sepsis were 69.2%, 92.3%, 61.5% and 50%, 50%,63.3%, respectively. Positive and negative predictive values were 37.50%, 44.44%, 42.10% and 78.94%, 93.75%, 79.16%, respectively.According to Cochran test there was no difference found between the 3 observers (p = 0.086). However, using Kappa test no agreementbetween I/T ratio and sepsis (p = 0.051) differences were found. from this study so far, the value in the diagnosis of neonatal sepsis theI/T ratio showed a low diagnostic.

Preterm Prelabor Rupture of Membranes: Outcomes with Expectant Management until 34 versus 35 Weeks

2018 ◽  
Vol 36 (07) ◽  
pp. 659-668
Author(s):  
Tara A. Lynch ◽  
Courtney Olson-Chen ◽  
Sarah Colihan ◽  
Jeffrey Meyers ◽  
Conisha Holloman ◽  
...  
Keyword(s):  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Expectant Management ◽  
Neonatal Morbidity ◽  
Estimating Equation ◽  
Antibiotic Administration ◽  
Fetal Demise ◽  
Maternal Sepsis ◽  
Nicu Admission ◽  
Prelabor Rupture Of Membranes

Objective To evaluate outcomes with expectant management of preterm prelabor rupture of membranes (PROM) until 35 weeks versus immediate delivery at ≥34 weeks. Study Design This was a multicenter retrospective cohort study of singletons with preterm PROM at >20 weeks from 2011 through 2017. Groups were defined as expectant management until 35 weeks versus immediate delivery at ≥34 weeks. Primary outcome was composite neonatal morbidity: need for respiratory support, culture positive neonatal sepsis, or antibiotic administration for >72 hours. Univariate and general estimating equation models were used with p < 0.05 considered significant. Results A total of 280 mother–infant dyads were included. There was no difference in composite neonatal outcome in pregnancies managed with expectant management compared with immediate delivery (43.4 vs. 37.5%; p = 0.32). Those with expectant management had shorter length of neonatal intensive care unit (NICU) admission but higher rates of neonatal antibiotics for > 72 hours, endometritis, and histological chorioamnionitis. There were no cases of fetal demise, neonatal death, or maternal sepsis, and only three cases of neonatal sepsis. Conclusion There is no difference in composite neonatal morbidity in pregnancies with preterm PROM managed with expectant management until 35 weeks as compared with immediate delivery at 34 weeks. Expectant management is associated with a decreased length of NICU admission but increased short-term infectious morbidity.

scholarly journals Procalcitonin is a Prognosis Biomarker in Late Onset Neonatal Sepsis: A Pilot Study

2021 ◽  
Author(s):  
Valerie Ruetsch ◽  
Simon Barreault ◽  
Nolwenn Le Sache ◽  
Pierre Tissieres
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Area Under The Curve ◽  
Neonatal Morbidity ◽  
Good Prognosis ◽  
Operating Characteristics ◽  
Sepsis Diagnosis

Abstract Background. Neonatal sepsis contributes substantially to neonatal morbidity and mortality. Procalcitonin (PCT) is a recognized biomarker for the diagnosis of late-onset neonatal sepsis (LONS), however, little is known about the prognosis value of PCT in LONS. This study aims at assessing PCT value as a prognosis biomarker in preterm infants with LONS. Methods. Retrospective single center observational cohort. All premature infants (less than 32 weeks of gestational age) with LONS admitted in a tertiary neonatal intensive care unit.Discussion. Among the 59 preterm infants included in the analysis, 48 survived (81.4%, 48/59). Deceased patients had a significantly lower gestational age (p=0,025) and weight (p= 0,016) at the time of LONS diagnosis. Although PCT values were not different between both groups at the time of LONS diagnosis, it was more elevated during the first 24 hours in deceased patients (p=0,041). Accuracy of PCT for LONS prognosis ranged from 0.70 to 0.82 of area under the curve on reciever operating characteristics curves. Optimal PCT cut-off values at LONS diagnosis was 8,92 µg/L (Youden’s J index 0.53), 15.75 µg/L for PCT values during the first 24 hours (J index 0.56), and 6.74 µg/L between 24 and 48 hours after diagnosis (J index 0.54). The estimated survival probability at day 60 was above 95% for patient with a PCT value at sepsis diagnosis under 8,9 µg/L and less than 45% if higher (p<0.0001). Conclusion. A PCT value > 8.92 µg/L obtained at LONS diagnosis suspicion seems to be a good prognosis biomarker.

scholarly journals Isolation of Janthinobacterium lividum from early onset neonatal sepsis patients in Malaysia

2019 ◽  
Vol 19 (3) ◽  
pp. 2378-2389
Author(s):  
Sa’adatu Haruna Shinkafi ◽  
Shu’aibu Umar ◽  
Vasantha Kumari Neela ◽  
Sabariah Moh’d Noordin ◽  
Syafinaz Amin Noordin ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Bacterial Infections ◽  
Neonatal Intensive Care ◽  
Case Fatality ◽  
Pcr Analysis ◽  
Neonatal Septicaemia ◽  
Janthinobacterium Lividum ◽  
16S Rdna Pcr

Background: The term early onset neonatal septicaemia (EONS) refers to invasive bacterial infections that primarily involve the blood stream of neonates during the first 3 days of life. Although early onset neonatal septicaemia is relatively uncommon, it may be associated with case fatality rates of 15-30% and substantial morbidity in surviving infants.Objectives: This study describes an unusual septicaemia cases with Janthinobacterium lividum in neonatal Intensive Care Units.Methods: Bacterial causes of early onset neonatal sepsis in Kuala Lumpur Hospital Malaysia were investigated using broad range 16S rDNA PCR and sequencing. The bacterial DNA was isolated directly from blood without pre-incubation. All samples collected were equally cultured and incubated in automated BACTEC system.Results: Two hundred and fifty two neonates were recruited in this study with mean (SD) gestational age of 35.9. Neonates with J. lividum infection lacked microbiological evidence of septicaemia as their blood culture yielded no bacterial growth. However, the PCR analysis of these samples yielded 1100bp corresponding to bacteria species.Conclusion: This study demonstrates the value of PCR in detecting bacteria where special growth requirement is involved.Keywords: Janthinobacterium lividum, neonatal septicaemia, neonatal intensive care units.

scholarly journals Look Who’s Talking: Host and Pathogen Drivers of Staphylococcus epidermidis Virulence in Neonatal Sepsis

2022 ◽  
Vol 23 (2) ◽  
pp. 860
Author(s):  
Isabella A. Joubert ◽  
Michael Otto ◽  
Tobias Strunk ◽  
Andrew J. Currie
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Bacterial Infections ◽  
Late Onset ◽  
Neonatal Morbidity ◽  
Invasive Disease ◽  
Bacterial Invasion ◽  
High Resource ◽  
Increased Risk ◽  
Neonatal Icu

Preterm infants are at increased risk for invasive neonatal bacterial infections. S. epidermidis, a ubiquitous skin commensal, is a major cause of late-onset neonatal sepsis, particularly in high-resource settings. The vulnerability of preterm infants to serious bacterial infections is commonly attributed to their distinct and developing immune system. While developmentally immature immune defences play a large role in facilitating bacterial invasion, this fails to explain why only a subset of infants develop infections with low-virulence organisms when exposed to similar risk factors in the neonatal ICU. Experimental research has explored potential virulence mechanisms contributing to the pathogenic shift of commensal S. epidermidis strains. Furthermore, comparative genomics studies have yielded insights into the emergence and spread of nosocomial S. epidermidis strains, and their genetic and functional characteristics implicated in invasive disease in neonates. These studies have highlighted the multifactorial nature of S. epidermidis traits relating to pathogenicity and commensalism. In this review, we discuss the known host and pathogen drivers of S. epidermidis virulence in neonatal sepsis and provide future perspectives to close the gap in our understanding of S. epidermidis as a cause of neonatal morbidity and mortality.

scholarly journals Risk factors and outcome of Klebsiella pneumonia sepsis among newborns in Northern India

2019 ◽  
Vol 7 (5) ◽  
pp. 1909
Author(s):  
Mahvish Qazi ◽  
Najmus Saqib ◽  
Rohit Raina
Keyword(s):  
Klebsiella Pneumoniae ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Clinical Manifestations ◽  
Antibiotic Sensitivity ◽  
Abdominal Distension ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Jammu And Kashmir ◽  
Sensitivity Pattern

Background: The increasing clinical incidence of antibiotic-resistant bacteria is a major global health care issue. Among MDR pathogens, Klebsiella pneumoniae (KP) is one of the world's most dangerous superbugs; and becoming resistant to virtually every antibiotic available today. The objective were to study the clinical characteristics of neonatal sepsis caused by KP and the antibiotic sensitivity pattern of Klebsiella pneumoniae in a neonatal intensive care unit (NICU) in northern india.Methods: This observational study was conducted with neonates who were admitted in NICU of Government Medical College (GMC) Jammu (Jammu and Kashmir) India and whose blood culture showed growth of KP in a study period of 1 year between 1st January 2018 to 31st December 2018. The data was entered into a register and presented by descriptive statistics.Results: Twenty four neonates were included in the study. The clinical presentations include refusal of feed (83.3%), lethargy (79.2%), respiratory distress (70.8%), shock (70.8%), fever (37.5%) or hypothermia (58.3%), apnea (29.2%) and abdominal distension (33.3%). Most common perinatal risk factor was prolonged labor (>24 h) seen in 79.2% of cases. C-reactive protein (CRP) level was positive in 95% of the cases. The mortality was 25%. KP strains were sensitive to colistin, polymyxin B, cotrimoxazole and tetracyclines.Conclusions: The clinical manifestations of neonatal sepsis caused by KP are usually non-specific. CRP detection is valuable for early diagnosis of sepsis. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care.

scholarly journals Bacteriological Profile of Neonatal Sepsis in a Neonatal Intensive Care Unit of a Tertiary Care Hospital of Eastern Nepal

2019 ◽  
Vol 15 (2) ◽  
pp. 93-97
Author(s):  
Sunil Kumar Yadav ◽  
Arun Giri
Keyword(s):  
Intensive Care ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
College Teaching ◽  
Neonatal Morbidity ◽  
Care Hospital ◽  
First Line ◽  
Cross Sectional ◽  
Clinical Sepsis

Background: Neonatal sepsis is a common and serious problem of neonates who are admitted for intensive care. It is a leading cause of neonatal morbidity and mortality worldwide. The objective of the study was to detect the common causative microorganisms of neonatal sepsis and their antibiotic susceptibility patterns in NICU of Nobel Medical College Teaching Hospital (NMCTH). Methods: This was a cross-sectional study conducted in a 17- bedded teaching and referral NICU of NMCTH from March to August, 2018. All neonates of clinical sepsis were enrolled in the study, blood cultures taken and were followed up till final outcome, which was discharge or death, irrespective of culture report. Descriptive statistics including percentages and frequencies was used.complications. Results: Among the 55 neonates with diagnosis of clinical sepsis, 13(23.6%) had shown bacteria in the culture. The predominant organisms were Staphylococcus aureus and Klebsiella pneumoniae and most of them were resistant to Ampicillin and Amikacin. Conclusions: The culture positivity rate among the neonates with clinical sepsis in the study was 23.6%. Pathogens isolated were resistant to the first line drugs for management of neonatal sepsis. Hence, the need for a review of first line drug for empirical treatment of neonatal sepsis.

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