1 1 BACKGROUND Neonatal bacterial sepsis NBS is defined as a clinical syndrome characterized by systemic signs and bacteraemia positive blood culture during the first four weeks of life 1 2 The signs of NBS are multiple non specific and include diminished spontaneous activity less vigorous sucking apnea bradycardia temperature instability respiratory distress vomiting diarrhoea abdominal distension jitteriness seizures and jaundice 3 Globally 2 6 million children died in the first month of life in 2016 approximately 7 000 newborns deaths every day most of which occurred in the first week with about 1 million dying on the first day and close to 1 million dying within the next six days Neonatal deaths accounted for 46 per cent of all under five deaths increasing from 41 per cent in 2000 4 Neonatal sepsis is the cause of substantial neonatal morbidity and mortality 3 It is estimated to cause 26 of all neonatal deaths worldwide 5 Its incidence changes over time and varies from a country to another 6 but compared with developed countries it is much higher in developing countries 2 6 with about 30 50 of the total of neonatal deaths 7 8 It is one of the most common reasons for admission to neonatal units in developing countries 6 Neonatal sepsis includes various systemic infections of the newborn such as sepsis meningitis pneumonia arthritis osteomyelitis and urinary tract infections
Superficial infections like conjunctivitis and oral thrush are not usually included under neonatal sepsis 9 Among them sepsis and meningitis are responsible for most of these deaths 10 Depending on the onset of symptoms neonatal sepsis can be classified into 2 types 1 Early onset Neonatal Sepsis EoNS and Late onset Neonatal Sepsis LoNS EoNS occurs within the first 72 hours of life and in severe cases the neonate may be symptomatic at birth The source of infection for EoNS is usually the maternal genital tract LoNS occurs after 72 hours of age 1 It is usually nosocomial as a complication of neonatal intensive care or community acquired This classification is important because it helps in determining the most probable pathogens and their mode of transmission This guides empiric treatment 3 The spectrum of organisms that causes neonatal sepsis and their antimicrobial susceptibility pattern changes over time and varies from a region to another even within the same hospital This is due to the changing pattern of antibiotic use and changes in lifestyle 1 6 In developed countries Group B Streptococcus GBS was the common etiological agent for neonatal sepsis followed by Escherichia coli and other organisms seen less frequently like the Streptococcus pneumonia Haemophilus influenza Listeria monocytogenes Coagulase negative Staphylococcus CoNS etc Meanwhile following the adoption of preventive strategies for GBS the predominant pathogen identified was Escherichia coli
The few data in developing countries reported an entirely different bacterial spectrum Since the discovery of antimicrobial agents microorganisms have developed resistance through mechanisms such as mutations and increased enzyme production 11 Resistance to commonly used antibiotics is an important problem worldwide 12 The local epidemiology of neonatal sepsis should be constantly updated to detect changes in the pattern of causative organisms and their susceptibility to various antibiotics Early diagnosis and proper management of neonatal sepsis by rational antimicrobial therapy and supportive care can reduce mortality Blood culture is the gold standard for diagnosis of sepsis but blood culture reports are usually available beyond 48 to 72 hours Other blood investigations may be done in diagnosing the neonatal sepsis They include the full blood count and acute phase reactants such C reactive protein CRP and procalcitonin PCT But these ones are time dependent and should be performed 6 12 hours after the onset of inflammatory response Meanwhile these sepsis markers complement the assessment of clinical signs and risk factors in diagnosis of neonatal sepsis The total white cell count is not useful in diagnosing neonatal sepsis as it has a poor positive predictive value Actually there are a lot of studies assessing laboratory biomarkers in the diagnosis of neonatal sepsis But recent studies among them have suggested the usefulness of biomarker such as PCT and CRP for the early diagnosis of neonatal sepsis Procalcitonin is a precursor hormone of calcitonin whose concentration in the blood of healthy persons is low but is preferentially elevated in bacterial sepsis However Lower levels of procalcitonin may be seen in early sepsis or patients with localized infections but may be elevated in other non septic inflammatory states including cardiac arrest postoperative conditions acute pancreatitis or shock Additional markers such as CRP are therefore required to increase the diagnostic accuracy of PCT in diagnosis The raised levels of CRP in septic individuals correlate well with organ failure and increased risk of death Therefore in the absence of methods for detecting the pathogenic bacterial agent sepsis is diagnosed using clinical signs and increases in CRP levels Notwithstanding CRP lacks the ability to differentiate bacterial sepsis from other inflammatory conditions
Thus there is a need to find diagnostic tools for early diagnosis of neonatal sepsis and identifying the common bacteria causing such infections in every hospital and their susceptibility patterns in order to provide necessary information for timely intervention
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"Neonatal bacterial sepsis NBS is defined as a Clinical Syndrome" Noplag, 16-Feb-2020. [Online]. Availible: https://noplag.com/free-essays/neonatal-bacterial-sepsis-nbs-is-defined-as-a-clinical-syndrome . [Accessed: 18-Apr-2024]
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