FOR Neo Sepsis Delhi the Anti Microbial.pptx

Neo Natal sepsis

1. Neonatal sepsis may be categorized as early onset (day of life 0-3) or late onset (day of life 4 or later) and is historically based on data derived from developed world. EOS is traditionally thought to be caused by organisms such as group B streptococcus and enteric Gram-negative bacteria, acquired peripartum from the maternal genital tract . LOS, on the other hand, is considered to arise due to the acquisition of pathogens during hospitalisation With worldwide increase in the prevalence of Gram-negative neonatal sepsis, this distinction is getting blurred , particularly from LMICs , in view of predominance (up to 64% ) of Gram-negatives and with hospital-associated infections of MDR bugs. Limited community studies available also suggest predominance of Gram Negatives There is strong need for future neonatal sepsis studies to move towards reporting of age of onset as a continuous variable to, which can better inform treatment and prevention strategies Finally for Neonatal sepsis: need for consensus definition

2. AI in Neonatal Sepsis The U se of AI in the filed of medicine has definitely revolutionized the detection of lung, brain, and breast cancer in adults Based on this success, the application of AI in neonatal critical is being explored A Research conducted by Hsu  et al . showed that an AI program utilizing ML techniques could correctly forecast the mortality of newborns suffering from respiratory failure.  A machine-learning technique was developed to forecast neonatal hypoxic-ischemic encephalopathy using neuroimaging data.  Drukker   et al . utilized AI with 84% specificity and 92% sensitivity to predict sepsis in newborns Its application has also been found to be helping the early diagnosis of conditions like RDS from chest radiographs,  apnea of prematurity (AOP) ,ROP in premature babies, NEC and so on. But the important limiting factor is the collection of robust data and absolute information, inclusion and sensitization of the other stake holders like OBG colleagues. Right now seems to be an evolving field with innumerable chalanges but going to be very useful in the coming times

3. Empiric 1 st and 2 nd line antibiotic policy For inborn babies: Amikacin + Cipro For Out born Babies (Referred from other centres ): a) Antibiotics Naïve (Non-CNS Infections) : Piperacillin+ Tazobactams b) If on appropriate antibacterials: continue the same and modify as per the culture reports Or Can formulate their Antibacterial plan based on the AMR data available from the nearby Institution

4. How long should one wait to say that the culture report is negative Automated culture methods invariably give signal after 36-48 hrs , maximum for five days with automated and upto seven days with conventional methods. No specific difference between the growth of Gram negatives and positive organisms. If one is sure of the optimum culture techniques, and baby is asymptomatic after 36-48 hrs , can stop the antibiotics after 48 hrs.