A Study Of Early Onset Neonatal Sepsis With Special Reference To Sepsis Screening Parameters In A Tertiary Care Centre Of Rural India

Objective: To study the maternal risk factors and clinico-bacteriological profile of early onset sepsis (EOS) and performance of sepsis screen parameter in a tertiary care neonatal unit. Methods: Relevant data of neonates born during the study period were obtained from their case records. A diagnosis of early onset sepsis was made if either clinical sepsis developed within 48 hours of life and based on the risk factors and/or clinical features were subjected to various hematological screening parameters and blood cultures. Data was analyzed using the SPSS software, Chi-square values, probability coefficients, sensitivity, specificity, positive predictive values and negative predictive values of the three diagnostic methods derived and the results correlated.Results: Among 3574 live births, a total of 189 episodes of sepsis occurred in 72 neonates (51.38% culture proven) with an incidence of 52.88 per 1000 live births. The incidence of EOS was 20.15 per 1000 live births and it constituted 38% of overall sepsis. Among the Perinatal risk factors assessed, a significant association of EOS with prolonged rupture of membranes, foul smelling liquor was observed (p<0.05). Among infants at risk of EOS, 20.9% developed sepsis compared to only 0.32% of those without these risk factors (p 0.001). Klebsiella pneumoniae being commonest (48.6%) isolate. A positive Buffy coat smear was the single best reliable sepsis screen test with a high specificity (82.7%) but, the positive predictive value and specificity was high when two or more sepsis screen tests were combined. Conclusion: Screening for sepsis in an asymptomatic neonate is warranted only in the presence of a maternal risk factor even if the neonate is at high risk of developing sepsis due to associated problems of prematurity, low birth weight or asphyxia. The sepsis scoring system in predicting neonatal septicemia clinically needs further evaluation. Blood culture remains the gold standard for the diagnosis of neonatal septicemia. Combination of two or more sepsis screen parameters has better results in diagnosing neonatal septicemia compared to a single test while awaiting the blood culture results