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Garg, Moksud, Anchan, Dube, Kar, and Mosaad: Prevalence, clinicobacteriological profile and maternal risk factor analysis of early-onset sepsis in the neonatal unit of a tertiary care hospital

Introduction: Early-onset sepsis (EOS) is defined as an infection that occurs before 7 days of age and is a common cause of neonatal hospitalization with a high fatality rate. The clinical features are non-specific and include refusal to feed, respiratory distress, lethargy, convulsions, jaundice and temperature instability. The causative agent is acquired from the mother by ascending infection during delivery or via the transplacental route. A range of maternal and neonatal risk factors contribute to the development of sepsis and the gold standard for diagnosis is the isolation of bacteria by cultures.

Aims and objectives: The aim of the study was to investigate the prevalence of early-onset neonatal sepsis in a tertiary care hospital and to study the clinicobacteriological profile as well as maternal and neonatal risk factors in neonates with EOS.

Materials and methods: This retrospective observational study was conducted in the neonatal unit of Saqr Hospital, Ras Al Khaimah, United Arab Emirates, and case records of EOS from January 2011 to December 2013 were studied and analysed.

Results: A total of 115 cases of EOS were studied. Blood culture was positive in 34 children (29.6%), and 30 infants (88.2%) were admitted to hospital within 24 hours of birth. The mean hospital stay was 8.1 days (standard deviation 2.05 days). Group B streptococcus (29.4%) and Escherichia coli (20%) were the most commonly isolated organisms, and the most common symptom was respiratory distress (in 60% of cases). Premature rupture of the membranes (in 47% of cases) and prematurity (in 35% of cases) were the most common risk factors. A total of 9 out of 34 babies (26%) developed sepsis despite the absence of any maternal risk factor. Positive correlations were obtained when comparing (1) the risk of sepsis in preterm babies with that of full-term babies with at least one maternal risk factor [relative risk (RR) 6.2], (2) the likelihood of sepsis in low- and normal-birthweight babies with low/normal Apgar scores (≤ 7 vs. > 7) (RR 1.8) and (3) the mode of delivery with hospitalization period, which showed that hospitalization is prolonged in babies born vaginally (RR 1.2).

Conclusion: Sepsis is a very common cause of hospitalization in neonates worldwide. Studies such as this one are of paramount importance for implementing and reinforcing correct and sensible antibiotic usage and proper infection control measures and for forming recommendations for antenatal screening.

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