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Abstract

TO STUDY THE DIFFERENT CLINICAL PRESENTATIONS OF NEONATAL SEPSIS AND THE RISK FACTORS IN BABIES PRESENTING WITH NEONATAL SEPSIS

Irfan Qayoom*, Sheikh Quyoom Hussain and Syed Yusra Imtiyaz

Abstract

Background: Neonatal septicemia or sepsis neonatorum refers to systemic infection of the new born. It is a clinical syndrome of systemic illness accompanied by bacteremia occurring in the first month of life. Prompt recognition, appropriate antimicrobial therapy and judicious supportive care are the key determinants of positive outcome in this serious pediatric emergency. Sepsis is the commonest cause of neonatal mortality and is probably responsible for 30% - 50% of the neonatal deaths each year in developing countries. The reported incidence of neonatal sepsis is 38 per 1000 live births in Asia. The incidence is lower in western countries. According to Neonatal Perinatal Database (NNPD) last reported data collected in 2002-2003 from 18 various parts of India, the incidence of neonatal sepsis has been reported to be 29 per 1000 live births. According to WHO estimates, there were about 5 million deaths in 1995, 98% of them occurred in developing countries. Aim: To study the different clinical presentations of neonatal sepsis and the risk factors in babies presenting with neonatal sepsis Methods: This study was a prospective observational study in neonatology section of Post Graduate Department of Pediatrics at GB Panth hospital, an associated tertiary care pediatric hospital of Government Medical College Srinagar, Northern India, from1st April 2018 to May 30 2019. Results: A total of 5128 neonates were admitted in our neonatology during this study period. Out of these a total of 414 neonates presenting with a wide spectrum of clinical signs and symptoms were diagnosed with neonatal septicemia. Among these 414 neonatal septicemia cases 265 neonates were inflicted with community acquired sepsis and 149 neonates developed Nosocomial sepsis. In our study the commonest presenting feature was lethargy/ refusal of feeds observed in 66.18% (274 cases) followed by hypothermia 44.20% (183), tachypnoea 40.09% (166 cases), grunting 32.12% (133 cases), delayed CRT 29.95% (128 cases), feeding intolerance 29.95% (124), prolonged jaundice 14.97% (62), Oliguria 11.83% (49), irritability 9.90% (41), seizures 9.17% (38), diarrhea 7% (29), vomiting 4.83% (20), abscesses 3.38% (14), umbilical discharge 1.93% (8) and pustulosis. 96% (4) respectively. In our study low birth weight (wt18hours in mother in 31.88%, delivery at home in 22.22 %, positive pressure ventilation in 20.29%,Perinatal asphyxia in 13.77%, maternal fever during labour in 10.62%,multiple intrapartum vaginal examinations (>3) in mother in 4.59%,Chorioamnionitis in 3.62%,central venous arterial catheterization in 3.14% and purulent foul smelling vaginal discharge in 2.89%. Conclusions: Clinical assessment using a combination of symptoms and signs are useful guides to provisional diagnosis of neonatal sepsis. Prevalence of sepsis is inversely related to birth weight and gestational age. High degree of culture positivity is noted in neonatal sepsis.

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