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sepsis

1. A study on diagnosis of neonatal sepsis in sepsis screen positive neonates by simultaneous two site blood culture sample Guide - Dr. PADMINI ASSOCIATE PROFESSOR Department of PAEDIATRICS, M.G.M Hospital, Warangal By Dr.K.Anjani , First Year Post Graduate, Department of Paediatrics.

2. INTRODUCTION Sepsis is one of the most common cause of neonatal mortality globally. Most infection –related deaths in the neonatal period occur in low income and middle income countries due to poor hygiene and suboptimal practices for infection control. Sepsis related mortality is largely preventable with prevention of sepsis itself , timely recognition , rational antimicrobial therapy and aggressive supportive care’

3. DEFINITIONS AND TERMS DEFINITION: neonatal sepsis is clinical syndrome characterized by signs and symptoms of infections with or without accompanying bacteremia in the first month of life . It encompasses various systemic infections of the newborn such as septicemia , meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections. Superficial infections like conjunctivitis and oral thrush are not usually included under neonatal sepsis.

4. DEFINITION AND TERMS Sepsis screen components and abnormal values 1)Total leukocyte count<5000/ cumm . 2) absolute neutrophil count (low counts as per Manroe chart for terms and Mouzinho’s chart for VLBW infants) 3) immature to total neutrophil ratio >0.2 4) micro ESR (>15mm in 1 st hr) 5) CRP >1mg/dl If two or more parameters are abnormal ,it is considered as a positive screen.

5. NEED FOR THE STUDY Early diagnosis and targeted therapy are essential for reducing the burden of neonatal sepsis in terms of mortality and emerging antibiotic resistance . To increase the yield of blood cultures ,since blood culture remains as the gold standard test for diagnosis of neonatal sepsis .

6. AIMS AND OBJECTIVES OF THE STUDY To evaluate efficacy of two blood culture samples taken simultaneously from two different sites as compared to the conventional single blood culture sample for diagnosis of neonatal sepsis in sepsis screen positive neonates.

7. SUBJECTS AND METHODS A detailed clinical examination of the neonates including vitals will be recorded. Patients anthropometry will be documented. LAB INVESTIGATIONS - Complete Blood picture with absolute neutrophil count, C- reactive protein ,micro ESR, Complete Urine Examination, Blood sugar levels, Serum Electrolytes which includes sodium, potassium, chloride, two blood culture samples from two different sites and radiological investigations if necessary.

8. CRITERIA INCLUSION CRITERIA- 1) presence of atleast one clinical feature with 2 or more risk factor for sepsis, 2) foul smelling liquor or presence of 3 or more risk factors. Risk factor for sepsis( prolonged rupture of membranes, foul smelling liquor ,maternal fever within 2weeks of delivery/during labour ,multiple vaginal examinations, delayed cry , dai handling ,APGAR<4 at 1min,prematurity,previous hospital stay and history of faulty feeding). EXCLUSION CRITERIA: - Patients who already received antibiotics before blood culture sampling . - Local sepsis in neonates

9. STUDY DESIGN-PROSPECTIVE COHORT STU DY SAMPLE SIZE – will be calculated using fishers formula TIMELINE – Oct 2022 to Sep 2024

10. METHODOLOGY This is a Prospective study which includes neonates of >30 weeks to 28 days of life admitted to NICU, Department of paediatrics ,Mahatma Gandhi Memorial Hospital, Warangal from Oct 2022 to Sept 202 4 who also fulfil the criteria of inclusion and exclusion. All the patients would be subjected to thorough clinical examination, laboratory and required imaging would be carried out. Depending on the magnitude of the disease required treatment would be carried out. All the clinical data of each patient will be recorded in the pre-coded clinical proforma designed for the study. In foul smelling liquor or presence of more than or equal to 3 antenatal risk factors ,blood culture sample is sent with/without sepsis screen positive. Blood culture samples are sent are labelled as sample 1 and sample 2.

11. REFERENCES 1. Bedi N, Gupta P. Antimicrobial stewardship in pediatrics: An Indian perspective. Indian Pediatr . 2016;53:293-8. 2. Baltimore RS. Neonatal nosocomial infections. SeminPerinatol . 1998;22:25-32. 3 Sarkar S, Bhagat I, DeCristofaro JD, Wiswell TE, Spitzer AR. A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis. J Perinatol . 2005;26:18-22. 4. Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev. 2006;19:788-802. 5. Agarwal J, Bansal S, Malik GK, Jain A. Trends in neonatal septicemia: emergence of non- albicans Candida. Indian Pediatr . 2004;41:712-5. 6. Mirrett S, Weinstein MP, Reimer LG, Wilson ML, Reller LB. Relevance of the number of positive bottles in determining clinical significance of coagulase -negative staphylococci in blood cultures

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