scholarly journals Modified hematological sepsis score in early diagnosis of neonatal sepsis

2017 ◽  
Vol 5 (8) ◽  
pp. 3573
Author(s):  
Vani Krishnamurthy ◽  
Deepti Thandaveshwar ◽  
Srinivasa Murthy Doreswamy
Keyword(s):  
Blood Culture ◽  
Early Diagnosis ◽  
Neonatal Sepsis ◽  
Complete Blood Count ◽  
Early Stage ◽  
Clinical Signs ◽  
Likelihood Ratios ◽  
Diagnostic Ability ◽  
Ability Tests ◽  
Sepsis Score

Background: Diagnosis of neonatal sepsis at an early stage substantially reduces the mortality. The clinician often relies on laboratory parameters to support the clinical suspicion. As blood culture takes time and yield is low, hematological and biochemical parameters often guide to the diagnosis and management. Rodwell’s Hematological sepsis score (HSS) has a reasonable sensitivity but low specificity. Some of the parameters included in that scoring system are repetitive of same pathogenic mechanism. A modified HSS was developed by the authors by removing the repetitive parameters, increasing the weightage for low neutrophil count and adding a new parameter - nucleated RBC. Objective of the study was to compare the diagnostic ability of the modified hematological sepsis score with Rodwell’s hematological sepsis score.Methods: Prospective analytical study conducted in a tertiary level hospital. Neonates admitted to NICU and had complete blood count done were included. Babies with clinical signs of systemic inflammatory response syndrome and evidence of organ dysfunction were considered septic. They were classified as proven sepsis if the blood culture was positive. All the samples were scored for both HSS and modified HSS. The sensitivity, specificity and other diagnostic ability tests were compared between the two scoring systems.Results: Total of 75 neonates were enrolled. 25 of them had sepsis and three had blood culture positive. At a score of 3, the sensitivity and specificity of HSS was 80 and 70% and that of Modified HSS was 84 and 82% respectively.Conclusions: Modified hematological score improves the specificity and likelihood ratios without decreasing the sensitivity in early diagnosis of neonatal sepsis.

scholarly journals CAN BASE EXCESS BE USED FOR PREDICT TO NEONATAL SEPSIS IN PRETERM NEWBORNS?

2019 ◽  
Vol 11 (1) ◽  
pp. e2019014 ◽  
Author(s):  
Sema Arayıcı
Keyword(s):  
Early Diagnosis ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Base Excess ◽  
Early Stage ◽  
Clinical Signs ◽  
Clinical Syndrome ◽  
Gas Analysis ◽  
Healthy Controls ◽  
Mortality And Morbidity

Background: Neonatal sepsis remains an important and potentially life-threatening clinical syndrome and a major cause of neonatal mortality and morbidity. The aim of this study to investigate whether values of base excess before the onset of clinical signs and symptoms of sepsis indicate infection in the early diagnosis of neonatal sepsis. Methods: In this study a total of 118 infants were enrolled. The infants were classified into two groups: group 1 (sepsis, n=49) and group 2 (control, n=69). Blood gas analysis investigated for screening of neonatal sepsis. Results: A total of 49 newborns with neonatal sepsis and 69 healthy controls were enrolled. A comparison of markers of sepsis revealed C-reactive protein, interleukin-6 level to be significantly higher and pH, pCO2, HCO3 and base excess values to be significantly lower in newborns with sepsis compared healthy controls (p<0.01). The optimum cut-off value in the diagnosis of neonatal sepsis was found to be -5 mmol/L for base excess. Sensitivity, specificity, positive predictive value and negative predictive value of this base excess cut-off for neonatal sepsis were 75, 91, 86 and 84% respectively. Conclusion: This is the first study to determine the relationship between the decrease value of base excess and early stage of neonatal sepsis. If the value of base excess <-5 mmol/L without an underlying another reason, may need close follow up of infants for neonatal sepsis and it may help early diagnosis.

scholarly journals Role of procalcitonin in early diagnosis of neonatal sepsis

2017 ◽  
Vol 4 (2) ◽  
pp. 383 ◽  
Author(s):  
Fareedul Hasan ◽  
Shamshad A. Khan ◽  
Maharoof M. K. ◽  
Niyaz Muhammed
Keyword(s):  
Blood Culture ◽  
Early Diagnosis ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Clinical Signs ◽  
P Value ◽  
Gastric Aspirate ◽  
College Hospital ◽  
Mortality And Morbidity ◽  
Early Onset Sepsis

Background: Neonatal sepsis is the most common cause for neonatal mortality and morbidity in India, Therefore it is essential that we diagnose early onset sepsis using clinical signs and symptoms and rapid diagnostic techniques and start appropriate treatment without any delay. Various diagnostic tests that differentiate infected and non-infected neonates particularly in the first few days of life can potentially make significant impact on the neonatal care.Methods: This was a hospital based clinical prospective study, done in the NICU department of pediatrics at Yenepoya medical college hospital, from January 2013 to December 2013. Sample size in this study was 50. All consecutive neonates fulfilling the inclusion and exclusion criteria were subjected to investigations like serum Procalcitonin, CRP, Total count, Gastric aspirate, Peripheral smear and Blood culture before starting treatment with antibiotics. Positive blood culture was taken as proven sepsis. The results obtained from our study parameters were statistically compared with cases of proven sepsis. Results: In our study 16(32%) out of 50 neonates had proven sepsis. In comparison to the other  markers of neonatal sepsis Elevated levels of serum Procalcitonin was found to be the most sensitive test with sensitivity of 100%, specificity of 50%, positive predictive value of 48.5%and negative predictive value of 100% and with a very highly significant p value of <0.001.Among the levels of PCT moderately elevated (2-10ng/dl) had sensitivity of 100%, specificity of 84.5%, PPV of 62.5% and NPV of 100% and highly elevated (>10ng/dl) had sensitivity of 100%, specificity of 80%, PPV of 75% and NPV of 100%.Conclusions: The use of procalcitonin in the diagnosis of neonatal sepsis has proved to be very useful compared to other regular sepsis markers. Procalcitonin performs better than CRP in the diagnosis of neonatal infection. Serum Procalcitonin levels >2 ng/dl has got a better sensitivity; PPV and NPV thus help us not only in the early diagnosis and also in the prognosis of the treatment and helps us in guiding in reducing the unwanted usage on antibiotics.

scholarly journals Osteoarthritis in pet guinea pigs: an update on diagnosis, treatment and management

2021 ◽  
Vol 26 (6) ◽  
pp. 100-106
Author(s):  
Emma Keeble
Keyword(s):  
Quality Of Life ◽  
Early Diagnosis ◽  
Guinea Pigs ◽  
Advanced Disease ◽  
Early Stage ◽  
Clinical Signs ◽  
Nutritional Supplements ◽  
Lifestyle Changes ◽  
Early Age

This article reviews the current literature on osteoarthritis in pet and laboratory guinea pigs. The associated clinical signs, diagnosis and treatment of osteoarthritis in pet guinea pigs will be discussed, with options for analgesia detailed. This condition is thought to be common in pet guinea pigs, even from an early age in some genetic lines, although osteoarthritis often goes undiagnosed in this species until advanced disease is present, posing a major welfare concern. Increasing awareness of this condition in veterinary practitioners should aid early diagnosis in pets and help improve their quality of life. Prevention may be possible using oral protective nutritional supplements to slow down the progression of this disease at an early stage. Lifestyle changes are also discussed for the management of this condition in pet guinea pigs.

scholarly journals Clinical and Bacteriological Profile of Early Onset Neonatal Sepsis Admitted in NICU of Tertiary Hospital in Biratnagar

2018 ◽  
Vol 3 (1) ◽  
pp. 370-376
Author(s):  
Arun Giri ◽  
Vijay Kumar Sah ◽  
Bikash Sharma Poudel ◽  
Niraj Niraula ◽  
Raju Sedai
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Coagulase Negative Staphylococcus ◽  
Sensitivity Pattern ◽  
Clinical Signs And Symptoms

Introduction: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality especially in developing countries. The clinical signs and symptoms of neonatal sepsis are non specific and blood culture report is considered gold standard for confirmation of neonatal sepsis. Organisms and their sensitivity pattern vary from place to place. The confirmation of diagnosis and management of neonatal sepsis is challenging and time consuming.Objective: The aim of this study was to find incidence of blood culture proven sepsis in suspected early onset neonatal sepsis, find out sensitivity pattern of isolated organism and to find association of risk factors and clinical signs and symptoms with blood culture proven sepsis.Methodology: Prospective study was conducted in Nobel Medical College, Biratnagar from November 2016 to November 2017. Sample size was calculated to be 300 and blood culture was sent of each neonates admitted with suspected early onset neonatal sepsis before giving neonates with first dose of antibiotics and report of 72 hours was taken into consideration.Results: Out of 300 cases of suspected early onset neonatal sepsis 70.3% presented with lethargy, followed by other symptoms like poor feeding, respiratory distress, fever, hypothermia, feeding intolerance, abnormal body movement and abdominal distension. Low birth weight neonates, preterm neonates, prolonged duration of per vaginal leaking and low platelets count were significantly associated with blood culture proven sepsis in this study. Incidence of blood culture positive sepsis in suspected early onset neonatal sepsis was 27%. Coagulase negative Staphylococcus aureus(21%) was predominant organism isolated followed by Klebsiella Pneumonia, Pseudomonas, Escherichia coli. All of the isolated Klebsiella and Pseudomonas and 86% of Escherichia coli were found to be resistant to ampicillin. All isolated Coagulase negative Staphylococcus aureus were sensitive to vancomycin.Conclusion: Coagulase negative Staphyloccus aureus was predominant organism detected but majority of organisms were gram negative organisms. High resistance to ampicillin was found and cefotaxime was also less sensitive to isolated organism. Vancomycin was found to be sensitive to all isolated Staphylococcus aureus and coagulase negative Staphylococcus aureus. Amikacin was highly sensitive among causative organisms isolated. BJHS 2018;3(1)5 : 370-376

scholarly journals Role of Serial C-reactive Protein (CRP) in Relation to Total Leucocyte Count, Platelet Count & Blood Culture for early Diagnosis of Neonatal Septicemia in Developing Countries

2015 ◽  
Vol 32 (2) ◽  
pp. 61-65
Author(s):  
Chiranjib Barua ◽  
Md Nurul Anwar ◽  
Md Shahidullah ◽  
Shahadat Hossain ◽  
Sharmila Barua ◽  
...  
Keyword(s):  
Developing Countries ◽  
Blood Culture ◽  
Early Diagnosis ◽  
Neonatal Sepsis ◽  
Leucocyte Count ◽  
Control Group ◽  
Total Leucocyte Count ◽  
C Reactive Protein ◽  
Neonatal Septicemia ◽  
Reactive Protein

Neonatal septicemia is a clinical syndrome of systemic illness accompanied by bacteremia occuring in the first 28 days of life. Neonatal septicemia is one of the major causes of neonatal death in developing countries. Early diagnosis and treatment can prevent neonatal mortality and morbidity. The present study includes: 1) usefulness of CRP (C-reactive protein), Total Leucocyte Count, Platelet Count and Blood Culture in early diagnosis of Neonatal Sepsis, 2) significance of serial CRP in diagnosis of neonatal sepsis. 3) the prognostic value of CRP in neonatal sepsis. This is a prospective study done in neonatal ward, Chittagong Medical College Hospital and carried out from January 2008 to January 2011. Sample size was 300. One hundred fifty neonates with suspected sepsis as cases and 150 healthy babies as control were enrolled in this study. Seventy two percent of cases neonates were preterm and low birth weight. Common risk factors for neonatal septicemia which were identified in this study; preterm (72%), low birth weight (72%), premature rupture membrane (60%), chorioamnionitis (26%) and maternal urinary tract infection (16%) . Out of 150 cases of suspected neonatal sepsis total 80.7%% had raised CRP, in initial sample 70.39% were CRP positive and in 2nd sample additional 9.31% case were CRP positive . In control group 91% were CRP negative. CRP was positive in 100% of culture proven sepsis. Sensitivity of CRP was 80.67% and specificity of CRP was 76.44%. Leucocytosis was observed in 7% of cases and leucopenia was found in 11% of cases. In 82 % cases leucocyte count was found normal. In control group, 95% had normal leucocyte count and 5% had leucocytosis but no leucopenia. Sensitivity of leucocyte count was 18% and specificity was 20.68%. Thrombocytopenia was found in 28% of case group. Out of 150 cases only 15.33% yielded growth of organisms in blood culture. Klebsiella was the most common pathogen isolated which was followed by E.coli and Strph. aureus. Sensitivity of blood culture was 15.33% and specificity was 100% Therefore serial CRP can be taken as alternative method for diagnosis of neonatal sepsis specially in developing countries where blood culture is not readily available.J Bangladesh Coll Phys Surg 2014; 32: 61-65

STUDY OF ABSOLUTE, IMMATURE NEUTROPHIL COUNT AND CRP AS DIAGNOSTIC MARKERS FOR EARLY ONSET NEONATAL SEPSIS.

2021 ◽  
pp. 25-26
Author(s):  
Pooja Poswal ◽  
Manisha Rohilla ◽  
Sunil Arora ◽  
Irbinder Kour Bali
Keyword(s):  
Blood Culture ◽  
Neutrophil Count ◽  
Neonatal Sepsis ◽  
Hematological Parameters ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Clinical Signs And Symptoms

Introduction: Neonatal Sepsis is difcult to differentiate from other conditions due to non- specic clinical signs and symptoms. Inammation in neonates shows variations in hematological parameters. Our study is to evaluate the hematological parameters and C-reactive protein estimation in neonatal sepsis for early diagnosis. Material And Methods: It was a cross-sectional study including 80 neonates admitted in the neonatal care unit, 40 (proven sepsis) and 40 probable cases); blood culture being the gold standard. Hematological parameters, immature to total neutrophil ratio (I/T ratio), Absolute neutrophil count (ANC), CRP and Blood culture were done as per standard protocols. Results: ANC had highest sensitivity of 90% followed by I/T ratio (87.5%) and CRP (77.5%). The sensitivity and specicity for the combination of ANC and I/T ratio was 78.3% and 83.6% respectively. Conclusion: ANC, I/T Ratio and CRP are quick, simple and cost-effective routine laboratory tests which help in neonatal sepsis prediction and to start proper and timely antibiotic therapy.

TLR2 and TLR4 expressions in late-onset neonatal sepsis: Is it a potential novel biomarker?

2020 ◽  
pp. 1-7
Author(s):  
R. Rohsiswatmo ◽  
M. Azharry ◽  
T.T. Sari ◽  
Y. Bahasoan ◽  
D. Wulandari
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Late Onset ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Tlr4 Expression ◽  
Cross Sectional ◽  
Reactive Protein

BACKGROUND: Late-onset neonatal sepsis (LONS) detection is problematic as no single examinations (blood culture, c-reactive protein (CRP), procalcitonin (PCT)) are reliable. Toll-like receptors (TLRs), which detect the presence of pathogen-associated molecular patterns is a promising novel biomarker, but less studied in LONS. This study aimed to determine neutrophils and monocytes TLR2 and TLR4 expression in LONS and their diagnostic value. METHODS: A cross-sectional study conducted in May and June 2017 involving 52 neonates with clinical late-onset (>72 hours of age) sepsis. We examine complete blood count, I/T ratio, CRP, PCT, as well as TLR2 and TLR4 expression to compared with blood culture as the gold standard. We classified cases into proven or unproven sepsis. RESULT: The incidence of LONS was 32.6% in the subjects. The expression of TLR2 was low in LONS, while TLR4 was high. TLR4 neutrophil expression has 88.2% sensitivity, 20% specificity, 34.9% positive predictive value (PPV), 77.8% negative predictive value (NPV), and an AUC of 0.541. TLR4 monocyte expression has 92.1% sensitivity, 11.4% specificity, 34% PPV, 80% NPV, and an AUC of 0.528. The AUC of CRP is increased from 0.608 to 0.843 after combination with TLR4, comparable with CRP + PCT (AUC 0.829). CONCLUSION: The increase in TLR4 expression has good sensitivity but low specificity. TLR4 expression, in combination with CRP, could become a reliable biomarker for the diagnosis of LONS.

scholarly journals A Study on Haematological Profile in Clinically Suspected Cases of Neonatal Sepsis

2020 ◽  
pp. 97-101
Author(s):  
S. R. Upadhey ◽  
Avinash M. Mane ◽  
Atul B. Hulwan ◽  
Rohit S. Kadam ◽  
Dhirajkumar Mane
Keyword(s):  
Blood Culture ◽  
Early Diagnosis ◽  
Observational Study ◽  
Neonatal Sepsis ◽  
Scoring System ◽  
Cost Effective ◽  
Clinical Findings ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Haematological Profile

The present study was a two year observational study of haematological profile in clinically suspected cases of neonatal sepsis. Study analyzed the haematological findings according to Rodwell’s haematological scoring system in neonates clinically suspicious of having sepsis. It included 108 neonates admitted in NICU of our hospital during the study period of June 2015 to May 2017. According to clinical findings, Rodwell’s hematological score and blood culture positivity 108 neonates were divided into three groups; proven sepsis, probable sepsis and no sepsis. Study show that Rodwell’s haematological scoring system is a simple, quick, cost effective tool which can be used as screening test for early diagnosis of neonatal sepsis.

scholarly journals Clinical profile of sepsis and choice of antimicrobials in babies admitted to special newborn care unit Kalaburagi

2021 ◽  
Author(s):  
Revanasiddappa Bhosgi ◽  
Kirankumar Harwalkar
Keyword(s):  
Blood Culture ◽  
Complete Blood Count ◽  
Early Recognition ◽  
Early Stage ◽  
Newborn Care ◽  
Neonatal Morbidity ◽  
Blood Parameters ◽  
Clinical Suspicion ◽  
High Index ◽  
Clinical Sepsis

Background: Sepsis is one of the common clinical conditions seen in neonates. Sepsis being major cause of neonatal morbidity and mortality in neonates, early recognition and treatment with antibiotics remains a mainstay of NICU protocols for neonatologists.Methods: It is a hospital based retrospective study conducted from July 2019 to February 2020 in GIMS, Kalaburagi. Neonates with suspicion of clinical sepsis were investigated for complete blood count (CBC), C-reactive protein (CRP) and blood culture (BC). Antibiotics were started based on CBC and CRP reports, or on high index of clinical suspicion. Based on common organisms isolated in previous 3 months statistics, antibiotics were decided. On confirmation by blood culture, antibiotics were changed as per blood culture report.Results: Out of 100 neonates, CRP was positive in  80 (70%) neonates, BC showed growth among 24 (24%) neonates. Although neonates had clinical sepsis, CRP was negative in 20 (10%), 76 (76%) did not show any kind of growth on BC. Mortality was seen in 04 (5%) neonates with only CRP positive, 02 (08%) neonates with only BC growth, 02 (10%) neonates with both CRP positive and BC growth, 02 (03%) neonates with CRP positive but no growth on BC. Clinical features were from subtle to severe.Conclusions: Although CRP and blood culture confirmation remains one of the main diagnostic parameter in sepsis, as mortality is seen among neonates with negative blood parameters, high  index of clinical suspicion is essential to treat sepsis at an early stage.

scholarly journals Neonatal sepsis definitions from randomised clinical trials

2021 ◽  
Author(s):  
Rían Hayes ◽  
Jack Hartnett ◽  
Gergana Semova ◽  
Cian Murray ◽  
Katherine Murphy ◽  
...  
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Laboratory Tests ◽  
Late Onset ◽  
Meta Analysis ◽  
Clinical Signs ◽  
International Consensus ◽  
Laboratory Findings ◽  
Diverse Range ◽  
Common Definition

Abstract Introduction Neonatal sepsis is a leading cause of infant mortality worldwide with non-specific and varied presentation. We aimed to catalogue the current definitions of neonatal sepsis in published randomised controlled trials (RCTs). Method A systematic search of the Embase and Cochrane databases was performed for RCTs which explicitly stated a definition for neonatal sepsis. Definitions were sub-divided into five primary criteria for infection (culture, laboratory findings, clinical signs, radiological evidence and risk factors) and stratified by qualifiers (early/late-onset and likelihood of sepsis). Results Of 668 papers screened, 80 RCTs were included and 128 individual definitions identified. The single most common definition was neonatal sepsis defined by blood culture alone (n = 35), followed by culture and clinical signs (n = 29), and then laboratory tests/clinical signs (n = 25). Blood culture featured in 83 definitions, laboratory testing featured in 48 definitions while clinical signs and radiology featured in 80 and 8 definitions, respectively. Discussion A diverse range of definitions of neonatal sepsis are used and based on microbiological culture, laboratory tests and clinical signs in contrast to adult and paediatric sepsis which use organ dysfunction. An international consensus-based definition of neonatal sepsis could allow meta-analysis and translate results to improve outcomes.

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