Early onset neonatal sepsis
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《美国医学杂志》
Pediatrics Department, BJ Medical College, Ahmedabad-380016, India
The article "Early Onset Neonatal Sepsis"[1] (EOS) is a study of 1743 live births in 15 months, from October 2000 to December 2001, that includes the colder post-monsoon months of Oct-Dec, twice which are likely to have low sepsis rates. There is an average of 3.8 births per day and a 12 month figure of 1394.
During this period, 136 babies who had potential maternal risk factors (MRF) and infants with features of altered body temperature, tachypnea/apnea, lethargy, poor feeding, shock and metabolic acidosis, were selected, in whom blood cultures were obtained soon after birth. The infant risk factors considered in the study are not exclusive for sepsis; they can be features of several morbidities like hypothermia, hyaline membrane disease, prematurity, and birth asphyxia. Other investigations like neutrophil counts etc. have not been mentioned. Of the 36 EOS only 15 were culture positive. How many of these were in the MRF positive versus negative category The incidence of sepsis in MRF negative group was 8 (22 %) vs 28 (78 %) in the positive group, so it is not negligible. Out of 8 babies in MRF negative group, 4 had 1-min Apgar score of <7. The matter of interest is the 15 culture positive babies in EOS group; their characteristics in detail could have been mentioned. The higher CFR of 19.4% in EOS vs 13.3% in the culture positive babies points to causes other than sepsis in the culture negative EOS babies.
The authors described in the introduction that EOS can occur at the time of resuscitation and few infants may develop EOS even without any identifiable MRF. In the conclusion they stated that irrespective of neonatal factors such as prematurity, asphyxia or VLBW, screening for EOS is warranted only in the presence of maternal risk factors, as the neonatal factors are more likely associated with late onset sepsis (LOS) than EOS. In this study, there were 29 LOS babies of whom 13 were culture positive. In these 13 babies the neonatal factors as mentioned are operative from the time of birth; so these babies with neonatal risk factors too need to be screened early, rather than late.
It may be appropriate to conclude that routine use of antibiotics for neonates in the absence of MRF is not warranted.
The population of 15 culture positive EOS babies is rather small to draw and recommend a conclusion that "screening for EOS is warranted only in the presence of maternal risk factors". And knowledge of the likely causative organisms and their sensitivity patterns can be obtained only after the 'screening' of babies in the neonatal units.
References
1. Chacko B and Sohi I. Early onset neonatal sepsis. Indian J Pediatr 2005; 72(1) : 23-26.(Gohil Jayendra R)
The article "Early Onset Neonatal Sepsis"[1] (EOS) is a study of 1743 live births in 15 months, from October 2000 to December 2001, that includes the colder post-monsoon months of Oct-Dec, twice which are likely to have low sepsis rates. There is an average of 3.8 births per day and a 12 month figure of 1394.
During this period, 136 babies who had potential maternal risk factors (MRF) and infants with features of altered body temperature, tachypnea/apnea, lethargy, poor feeding, shock and metabolic acidosis, were selected, in whom blood cultures were obtained soon after birth. The infant risk factors considered in the study are not exclusive for sepsis; they can be features of several morbidities like hypothermia, hyaline membrane disease, prematurity, and birth asphyxia. Other investigations like neutrophil counts etc. have not been mentioned. Of the 36 EOS only 15 were culture positive. How many of these were in the MRF positive versus negative category The incidence of sepsis in MRF negative group was 8 (22 %) vs 28 (78 %) in the positive group, so it is not negligible. Out of 8 babies in MRF negative group, 4 had 1-min Apgar score of <7. The matter of interest is the 15 culture positive babies in EOS group; their characteristics in detail could have been mentioned. The higher CFR of 19.4% in EOS vs 13.3% in the culture positive babies points to causes other than sepsis in the culture negative EOS babies.
The authors described in the introduction that EOS can occur at the time of resuscitation and few infants may develop EOS even without any identifiable MRF. In the conclusion they stated that irrespective of neonatal factors such as prematurity, asphyxia or VLBW, screening for EOS is warranted only in the presence of maternal risk factors, as the neonatal factors are more likely associated with late onset sepsis (LOS) than EOS. In this study, there were 29 LOS babies of whom 13 were culture positive. In these 13 babies the neonatal factors as mentioned are operative from the time of birth; so these babies with neonatal risk factors too need to be screened early, rather than late.
It may be appropriate to conclude that routine use of antibiotics for neonates in the absence of MRF is not warranted.
The population of 15 culture positive EOS babies is rather small to draw and recommend a conclusion that "screening for EOS is warranted only in the presence of maternal risk factors". And knowledge of the likely causative organisms and their sensitivity patterns can be obtained only after the 'screening' of babies in the neonatal units.
References
1. Chacko B and Sohi I. Early onset neonatal sepsis. Indian J Pediatr 2005; 72(1) : 23-26.(Gohil Jayendra R)