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Sepsis in the newborn.

R Aggarwal1, N Sarkar, A K Deorari

  • 1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.

Indian Journal of Pediatrics
|February 13, 2002
PubMed
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Neonatal sepsis, a leading cause of newborn deaths in India, is often caused by Klebsiella pneumoniae and Staphylococcus aureus. Early diagnosis and appropriate antibiotic use are crucial for improving outcomes in systemic infections.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Microbiology

Background:

  • Systemic infection is the primary cause of neonatal mortality globally.
  • Klebsiella pneumoniae and Staphylococcus aureus are identified as the most frequent pathogens responsible for neonatal sepsis in India, according to the National Neonatal Perinatal Database 2000.
  • Neonatal sepsis presents in two distinct forms: early-onset sepsis (within 72 hours of age), linked to perinatal factors and often manifesting as respiratory distress and pneumonia, and late-onset sepsis (after 72 hours of age), associated with hospital-acquired infections and typically presenting as septicemia and pneumonia.

Purpose of the Study:

  • To highlight the significant burden of neonatal sepsis in India.
  • To differentiate between early- and late-onset neonatal sepsis based on causative factors and clinical presentations.
  • To emphasize the need for a high index of suspicion for timely diagnosis due to non-specific clinical features of neonatal sepsis.

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Main Methods:

  • Review of data from the National Neonatal Perinatal Database 2000 to identify common pathogens.
  • Clinical observation and categorization of neonatal sepsis into early- and late-onset forms.
  • Discussion of diagnostic challenges, including the limitations of blood culture turnaround time (48-72 hours).

Main Results:

  • Klebsiella pneumoniae and Staphylococcus aureus are the predominant etiological agents of neonatal sepsis in India.
  • Early-onset sepsis typically presents with respiratory distress and pneumonia within 72 hours of birth.
  • Late-onset sepsis, often hospital-acquired, usually manifests as septicemia and pneumonia after 72 hours of age.

Conclusions:

  • Neonatal sepsis requires a high index of suspicion for prompt diagnosis due to its often non-specific clinical signs.
  • A practical septic screen has been developed to aid in the timely diagnosis of neonatal sepsis.
  • Protocols for appropriate antibiotic use in neonatal sepsis management have been suggested.