Recognition and management of neonatal sepsis

2021 ◽  
Vol 30 (7) ◽  
pp. 410-415
Author(s):  
Luke William Crocker ◽  
Ayesha White ◽  
Paul Anthony Heaton ◽  
Débora Pascoal Horta ◽  
Siba Prosad Paul
Keyword(s):  
Neonatal Sepsis ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Evidence Based ◽  
Suspected Sepsis ◽  
Serious Illness ◽  
Prompt Treatment ◽  
Serious Infection ◽  
Common Causes ◽  
Red Flag

Neonatal sepsis results from acute bacterial or viral infection occurring in the first 28 days of life. It causes significant morbidity and mortality, although the outcome can be improved by early recognition and prompt treatment by health professionals. This article describes the most common causes of sepsis, and explains why neonates are particularly vulnerable to infection. It highlights the non-specific way in which an infant with a serious infection may present, indicating the crucial features to elicit during history taking and examination, and emphasising the ‘red-flag’ signs and symptoms that should increase suspicion of a serious illness. The authors have adapted National Institute for Health and Care Excellence guidelines to produce an evidence-based approach to the management of an infant with suspected sepsis, and describe the roles of nurses in ensuring effective treatment and best outcomes for these babies.

scholarly journals Procalcitonin – A Reliable Marker for Diagnosis of Neonatal Sepsis in Compare to CRP

2018 ◽  
Vol 42 (1) ◽  
pp. 19-25
Author(s):  
Jesmin Akter ◽  
Forrukh Ahammad ◽  
Tahmina Begum
Keyword(s):  
Early Diagnosis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Early Recognition ◽  
Care Hospital ◽  
Suspected Sepsis ◽  
Reliable Marker ◽  
Serum Crp

Background: Early recognition and diagnosis of neonatal sepsis are difficult because of the variable and non-specific clinical presentation of this condition. It is extremely important to make an early diagnosis of neonatal sepsis for prompt institution of antimicrobial therapy. So the objective of the study was to evaluate the efficacy of serum procalcitonin as a reliable marker in diagnosis of neonatal sepsis.Methodology: This cross sectional analytical study was carried out in the Special Care Baby Unit of a tertiary level care hospital in Bangladesh from September 2012 to May 2013. Total 75 newborn with suspected sepsis were included in the study. Specimens of blood were obtained from each neonate prior to commencement of antibiotic for sepsis work up. Serum CRP and procalcitoninlevels were measured. The data from blood cultures were used as the gold standard to evaluate the optimum sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the Receiver Operative Characteristic (ROC) curves.Results:Among total 75 newborns included in this study, 49.3% (37) newborn were diagnosed as proven sepsis and 50.7% (38) newborn as clinical sepsis.The procalcitonin (PCT) was high in 58.7% (500-<2000 pg/ml) newborn and remarkably high (2000-<10000) in 36% newborn with sepsis. At a cut-off value > 500pg/ml, the sensitivity of PCT in detecting sepsis was 48.6%, its specificity 76.3%, positive predictive value was 66.7%, and negative predictive value was 60.4% whereas the sensitivity of CRP for predicting sepsis was 35.1%, specificity 78.9%, positive predictive value 61.9% and negative predictive value was 55.6%. The area under the ROC curve for procalcitonin(0.653) was significantly higher than CRP (0.571).Conclusion:Serum PCT was superior to serum CRP level in terms of early diagnosis of neonatal sepsis, in detecting the severity of sepsis. PCT is a reliable marker than CRP in the diagnosis of neonatal sepsis.Bangladesh J Child Health 2018; VOL 42 (1) :19-25

Continuous Ambulatory Peritoneal Dialysis Complicated by Fournier's Syndrome

1987 ◽  
Vol 7 (3) ◽  
pp. 193-194 ◽  
Author(s):  
J. Joseph Walshe ◽  
Padma V. Reddy
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Early Recognition ◽  
External Genitalia ◽  
High Morbidity ◽  
Prompt Treatment ◽  
Serious Infection ◽  
Scrotal Edema ◽  
Male External Genitalia

Two patients developed Fournier's syndrome while on continuous ambulatory peritoneal dialysis. In both cases, massive scrotal edema appears to have been the precipitating cause of the polymicrobial genital infection. Early recognition and prompt treatment of this syndrome is essential if one is to avoid the high morbidity and mortality associated with this disease. Fournier's syndrome, first described in 1883, is a fulminant necrotising subcutaneous infection of the male external genitalia (I). Although initially thought to be idiopathic, recent evidence suggests that an underlying condition can usually be identified as the precipitating cause of this rare but serious infection (2, 3). Herein, we describe two patients who developed massive scrotal edema while on continuous ambulatory peritoneal dialysis (CAPO). Subsequently, both patients suffered polymicrobial infections of the scrotum with necrosis. We discuss the possible role of CAPO and scrotal edema in leading to the development of Fournier's syndrome.

scholarly journals Recognition of sepsis in primary care: a survey among GPs

BJGP Open ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. bjgpopen17X100965 ◽  
Author(s):  
Feike J Loots ◽  
Roeland Arpots ◽  
Rick van den Berg ◽  
Rogier M Hopstaken ◽  
Paul Giesen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Clinical Decision Making ◽  
Early Recognition ◽  
Vital Signs ◽  
Signs And Symptoms ◽  
Clinical Decision ◽  
Altered Mental Status ◽  
Screening Tools ◽  
Serious Infection

BackgroundEarly recognition and treatment of sepsis are important to reduce morbidity and mortality. Screening tools using vital signs are effective in emergency departments. It is not known how the decision to refer a patient to the hospital with a possible serious infection is made in primary care.AimTo gain insight into the clinical decision-making process of GPs in patients with possible sepsis infections.Design & settingSurvey among a random sample of 800 GPs in the Netherlands.MethodQuantitative questionnaire using Likert scales.ResultsOne hundred and sixty (20.3%) of questionnaires were eligible for analysis. Based on self-reported cases of possible serious infections, the factors most often indicated as important for the decision to refer patients to the hospital were: general appearance (94.1%), gut feeling (92.1%), history (92.0%), and physical examination (89.3%). Temperature (88.7%), heart rate (88.7%), and blood pressure (82.1%), were the most frequently measured vital signs. In general, GPs more likely referred patients in case of: altered mental status (98.7%), systolic blood pressure <100 mmHg (93.7%), unable to stand (89.3%), insufficient effect of previous antibiotic treatment (87.4%), and respiratory rate ≥22/minute (86.1%).ConclusionThe GPs' assessment of patients with possible serious infection is a complex process, in which besides checking vital signs, many other aspects of the consultation guide the decision to refer a patient to the hospital. To improve care for patients with sepsis, the diagnostic and prognostic value of assessing the vital signs and symptoms, GPs' gut feeling, and additional diagnostic tests, should be prospectively studied in the primary care setting.

scholarly journals Red cell distribution width as predictor tool in critically ill neonate

2021 ◽  
Vol 8 (3) ◽  
pp. 517
Author(s):  
Kotyal B. Mahendrappa ◽  
Shravya S. Rao
Keyword(s):  
Critically Ill ◽  
Early Recognition ◽  
Rapid Test ◽  
Red Cell Distribution Width ◽  
Red Cell ◽  
Cell Distribution ◽  
Suspected Sepsis ◽  
Distribution Width ◽  
Predictive Values ◽  
Common Causes

Background: Neonatal sepsis is one of the most common causes for critically ill neonate. Early recognition and prompt treatment are crucial. Red cell distribution width (RDW) varies significantly in such conditions. This study aims at finding the relation between RDW and critically ill neonate.Methods: This hospital based prospective cohort study was conducted on 60 neonates with suspected sepsis. The RDW values were collected at admission and after 72 hours of admission. The primary outcome measures were mortality and recovery from illness. Statistical analysis was done using statistical package for the social sciences (SPSS) 22 version software with appropriate statistical methods applied.Results: The mean RDW in our study group was 14.788±2.138. Receiver operating characteristic (ROC) curve for RDW at 72 hours of admission revealed area under curve (AUC) 0.810 at 14% cut-off with sensitivity of 81.25%, specificity of 72.73%, positive predictive values (PPV) 52% and negative predictive values (NPV) 91.4% with p<0.0001.Conclusions: RDW is a simple, easily available, rapid test to predict the outcome in critically ill neonate.

scholarly journals Clinical and laboratory profile of pediatric scrub typhus in a tertiary care teaching hospital in Southern India

2018 ◽  
Vol 5 (6) ◽  
pp. 2092 ◽  
Author(s):  
Selvakumar Lakshmanan ◽  
Benjamin Sagayaraj M. ◽  
Balamma Sujatha ◽  
Lal Devayani Vasudevan
Keyword(s):  
Rural Areas ◽  
Scrub Typhus ◽  
Early Recognition ◽  
Monsoon Season ◽  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Clinical Suspicion ◽  
Common Causes ◽  
Positive Serum

Background: Scrub typhus is a common aetiology for an acute undifferentiated fever among children. Early recognition and prompt management help to reduce morbidity and mortality.Methods: All children who visited our pediatric out-patient department between January 2016 and February 2018, admitted with clinical suspicion of scrub typhus and having positive serum IgM by ELISA were included in the study.Results: A total of 83 cases were enrolled during the study period. Of these 55 were boys and 28 girls. The average age of presentation was seven years, and the youngest was just five months old. Majority of these patients were from rural areas (86%). Roughly, two-thirds (77%) of the study group practiced open defecation. A maximum number of cases (65;78.3%) were reported during monsoon season (between September and January).Prolonged fever (100%), gastrointestinal symptoms (76%) such as vomiting, diarrhoea and abdominal pain, lymphadenopathy (96%) and hepatosplenomegaly (61%) were common signs and symptoms of pediatric scrub typhus. Only six patients had severe illnesses. The diagnosis was based on the positive serum IgM for scrub typhus. All the patients were IgM positive. Out of these 83 patients, eschar was seen in 50 (60%) patients. Weil Felix test was positive in 15 cases out of 33 tested cases. Six children had co-infection with 2 cases of malaria and four dengue fever cases.Conclusions: Scrub typhus is one of the common causes for acute undifferentiated fever among children. A high index of clinical suspicion and a lookout for an eschar shall facilitate an early diagnosis of scrub typhus.

scholarly journals Salmonella entericaSerotype Arizonae Meningitis in a Neonate

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Wubishet Lakew ◽  
Abayneh Girma ◽  
Elizabeth Triche
Keyword(s):  
Cerebrospinal Fluid ◽  
Salmonella Enterica ◽  
Signs And Symptoms ◽  
Human Infection ◽  
Communicating Hydrocephalus ◽  
Gram Negative ◽  
Prompt Treatment ◽  
Salmonella Infections ◽  
Common Causes ◽  
Invasive Infections

Typhoidal and nontyphoidal salmonella infections are common causes of gastroenteritis in the community. However, salmonella only rarely causes invasive infections like meningitis. We report a 13-day-old female neonate with signs and symptoms of meningitis whose cerebrospinal fluid (CSF) culture showedSalmonella entericaserotype Arizonae that was sensitive to ceftriaxone. She presented with fever and failure to feed for 2 days. Despite prompt treatment with ampicillin, gentamicin, and ceftriaxone, she developed communicating hydrocephalus, frequent seizures, and coma that progressed to death after 2 weeks of hospitalization.Salmonella entericaserotype Arizonae is a rare cause of human infection known to leading to meningitis symptoms similar to those caused by other salmonella species. This is the first report of it as a cause of meningitis in a child under one month of age. Therefore, it should be included in the differential diagnosis of Gram-negative bacillary meningitis in immunocompromised children, neonates, and those with contacts with reptiles.

Recognition and management of sepsis: the nurse's role

2020 ◽  
Vol 29 (21) ◽  
pp. 1248-1251
Author(s):  
Greg Bleakley ◽  
Mark Cole
Keyword(s):  
Early Recognition ◽  
Screening Tools ◽  
Suspected Sepsis ◽  
Intervention Delivery ◽  
Nursing Role ◽  
Early Warning Scores ◽  
Red Flag ◽  
Time Critical ◽  
Sepsis Screening ◽  
Critical Intervention

Caring for a patient with suspected sepsis is a challenging nursing role. Early recognition and appropriate management of a patient with sepsis saves lives. Nurses play a fundamental role in detecting changes in physiological observations that could indicate the onset of sepsis. Additionally, an awareness of the pathophysiology of sepsis allows the nurse to better understand how rapid intervention prevents the onset of septic shock. Furthermore, knowledge and use of clinical guidelines and sepsis screening tools are established methods to help reduce patient mortality. Nurse familiarity with ‘red flag’ criteria for sepsis and thorough completion of early warning scores facilitate earlier recognition and time critical intervention. Delivery of the ‘sepsis six’ within 1 hour of suspected sepsis saves lives.

NEONATAL SEPSIS AND IDENTIFICATION OF RISK FACTORS: STUDY IN AVBRH HOSPITAL SAWANGI

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pramod P. Singhavi
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Signs And Symptoms ◽  
Premature Rupture ◽  
Maternal Risk ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Meconium Stained Amniotic Fluid

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

scholarly journals Japan’s voluntary lockdown: further evidence based on age-specific mobile location data

2021 ◽  
Author(s):  
Tsutomu Watanabe ◽  
Tomoyoshi Yabu
Keyword(s):  
Age Groups ◽  
Evidence Based ◽  
Intervention Effect ◽  
Information Effect ◽  
Mobile Location ◽  
Serious Illness ◽  
Location Data ◽  
Voluntary Response ◽  
Younger Age ◽  
Age Profile

AbstractChanges in people’s behavior during the COVID-19 pandemic can be regarded as the result of two types of effects: the “intervention effect” (changes resulting from government orders for people to change their behavior) and the “information effect” (voluntary changes in people’s behavior based on information about the pandemic). Using age-specific mobile location data, we examine how the intervention and information effects differ across age groups. Our main findings are as follows. First, the age profile of the intervention effect shows that the degree to which people refrained from going out was smaller for older age groups, who are at a higher risk of serious illness and death, than for younger age groups. Second, the age profile of the information effect shows that the degree to which people stayed at home tended to increase with age for weekends and holidays. Thus, while Acemoglu et al. (2020) proposed targeted lockdowns requiring stricter lockdown policies for the oldest group in order to protect those at a high risk of serious illness and death, our findings suggest that Japan’s government intervention had a very different effect in that it primarily reduced outings by the young, and what led to the quarantining of older groups at higher risk instead was people’s voluntary response to information about the pandemic. Third, the information effect has been on a downward trend since the summer of 2020. It is relatively more pronounced among the young, so that the age profile of the information effect remains upward sloping.

Laryngeal cancer

2021 ◽  
pp. 175573802110105
Author(s):  
Kelvin Miu
Keyword(s):  
Head And Neck Cancer ◽  
Early Diagnosis ◽  
Head And Neck ◽  
Patient Outcomes ◽  
Laryngeal Cancer ◽  
Neck Cancer ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Diagnosis And Treatment

Laryngeal cancer is a common head and neck cancer and typically presents with voice hoarseness in patients older than 60 years. Early recognition of signs and symptoms of laryngeal cancer can lead to early diagnosis and treatment, therefore improving patient outcomes. This article aims to provide an overview of the anatomy of the larynx, presentation and management of laryngeal cancer, and common follow-up problems.

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