Early neonatal sepsis: prevalence, complications and outcomes in newborns with 35 weeks of gestational age or more

ABSTRACT Objective: To analyze the incidence, complications, and hospital discharge status in newborns with ≥35 weeks of gestational age with early neonatal sepsis. Methods: This is a cross-sectional, retrospective study. Cases of early-onset sepsis registered from January 2016 to December 2019 in neonates with gestational age of 35 weeks or more were reviewed in a level III neonatal unit. The diagnoses were performed based on the criteria by the Brazilian Health Regulatory Agency (Anvisa), and the episodes were classified according to microbiological classification and site of infection. The following complications were evaluated: shock, coagulation disorders, and sequelae of the central nervous system. The conditions at hospital discharge were also assessed. The collected data were analyzed with the descriptive analysis. Results: In the period, early neonatal sepsis occurred in 46 newborns, corresponding to 1.8% of all newborns admitted to the neonatal unit, with a prevalence of 4/1,000 live births. Culture confirmed sepsis ocurred in three patients (0.3/1,000 live births), with the following agents: S. pneumoniae, S. epidermidis and S. agalactiae. As to site of infection, there were 35 cases of primary bloodstream infection, seven cases of pneumonia and four cases of meningitis. Most patients (78.3%) had at least one risk factor for sepsis, and all were symptomatic at admission. There were no deaths. Complications occurred in 28.2% of the cases, especially shock (10 cases – 21.7%). Conclusions: The prevalence of proven early neonatal sepsis was low. Despite the common occurrence of complications, there were no deaths.

Reliable and questionable diagnostic criteria for early0onset sepsis

Neonatal sepsis is a significant cause of mortality among newborns, especially in low and middle income countries with poor economic development. It is important to start the appropriate treatment as soon as possible, as this prevents most deaths from sepsis and reduces the occurrence of residual neurological lesions due to septic meningitis. The article provides an overview of modern literature data on the principles of diagnosis of early neonatal sepsis; mentions the main etiological factors and ways of infection by potential pathogens. Diagnostic criteria for early neonatal sepsis have been analyzed and have been classified as doubt-ful or credible. An important role is given to the assessment of potential risk factors for the development of the septic process, including data on history of pregnancy and childbirth, clinical and laboratory indicators of the baby after birth. The nonspecificity of most clinical signs of sepsis and their comparison with clinical manifestations in meningitis was carried out. The importance of the bacteriological method of detecting the pathogen in the blood, urine and cerebrospinal fluid was analyzed, which remains the «gold» standard diagnosis of neonatal sepsis, and the method of multiplex polymerase chain reaction. There is a need to detect sepsis through visual examination, such as chest radiography, computed tomography, magnetic resonance imaging and ltrasonography of the head. The diagnostic value of indicators is described with the complete blood cell count and differential, including some of its components, and markers of inflammatory process, especially the immature-to-total (I/T) neutrophil ratio, C-reactive protein, procalcitonin. The article mentions a method of determining the concentration of immunoglobulin M in the serum, the elevated level of which indicates intrauterine infection. The diagnostic value of glutathione is considered, which is a marker of the functioning of the immune system. Emphasis is placed on the expediency of using Kaiser Permanente calculator to detect signs of sepsis in the first days of a newborn's life and the choice of optimal tactics management in such patients. No conflict of interest was declared by the authors. Key words: sepsis, newborn, diagnosis of infection, neonatal.

RISK FACTORS OF NEONATAL SEPSIS

Objectives:To identify the risk factors of neonatal sepsisduring the period from January 2017 to December 2019. Methods:A cross-sectional, retrospective study, observational, descriptive; the record of 106 newborns diagnosed with sepsis were reviewed. We excluded 15 were included in the data collection, diagnosis of early and late neonatal sepsis, maternal age, number of gestation, prenatal care, premature birth, diagnosis of UTI diagnosis of chorioamnionitis, premature rupture of membrane (s RPM ), sex product, invasive procedures, product weight and route of obtaining the product. Results:Of the 1401 patients obtained alive, 191 obtained diagnosis of neonatal sepsis and an incidence of 6.49% of early neonatal sepsis was obtained. The main risk factor associated with early neonatal sepsis has been the way of obtaining caesarean with 52.74%, the low birth weight with 32.96% and multiparity an incidence of 34.06% and there were no significant differences between sexes as the man / femalerelationship was 1.02.However if a significant importance in the delivery / caesarean relationship was obtained0.89. There was only one death recorded. Conclusions:The main risk factors associated with early neonatal sepsis are obtained via caesarean section, low birth weight and multiparity, male sex was the most affected but with no significant differences, the IVU, PROM, maternal age less to 18 years and the lack of prenatal care they had similar incidence. Only one late neonatal sepsis and death was obtained. I do not chorioamnionitis data was obtained.

Evaluation of the Relationship between Clinical Outcome of Early Neonatal Sepsis and HIV Exposure in Homa bay County Referral Hospital, Western Kenya

Background: Maternal HIV is the leading cause of both maternal and child morbidity in Sub-Saharan Africa and very little is known about the relationship of HIV exposure and early neonatal sepsis. Objective: To describe the association between maternal HIV and probable or confirmed early neonatal sepsis in Homa Bay County Referral Hospital, Western Kenya. Design: Hospital based cross- sectional study. Study Setting: Homa Bay County Referral Hospital. Subjects/Participants: One hundred and forty two (142) neonates aged 24 hours to 96 hours. Results: Data purposively collected included, characteristics of women and newborns at enrollment, by maternal HIV status and HIV- positive women and their newborns, prevalence of probable or confirmed sepsis, factors in association between maternal HIV infection and probable sepsis in newborns and associations between HIV exposure and probable or confirmed sepsis among newborns and HIV-exposed newborns, 0(0.00%) HIV-positive by 24-hours PCR, prevalence of positive culture 1.6% in HIV-exposed, 1.7% HIV-unexposed with a prevalence ratio: 1.11 (95% CI: 0.05, 8.00) p-value = 0.8615. There was no statistical relationship between clinical outcomes of early neonatal sepsis to HIV exposure. Conclusion: There was no association between maternal HIV and probable or confirmed early neonatal sepsis in Homa Bay County Referral Hospital, Western Kenya.