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Case 2: Early-Onset Neonatal Sepsis in a Term Neonate

AUTHOR DISCLOSURES

Drs Dias Maia, Niermeyer, Palau, and Cataldi have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

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Paula Dias Maia , Susan Niermeyer , Mauricio A. Palau , Jessica R. Cataldi; Case 2: Early-Onset Neonatal Sepsis in a Term Neonate. Neoreviews June 2021; 22 (6): e402–e405. https://doi.org/10.1542/neo.22-6-e402

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Ahmad MS, Ali N, Mehboob N, Mehmood R, Ahmad M, Wahid A. Temperature on admission among cases of neonatal sepsis and its association with mortality. J Pak Med Assoc.. 2016; 66:(10)1303-1306

Bayston KF, Cohen J. Bacterial endotoxin and current concepts in the diagnosis and treatment of endotoxaemia. J Med Microbiol.. 1990; 31:(2)73-83 https://doi.org/10.1099/00222615-31-2-73

Cailes B, Kortsalioudaki C, Buttery J Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed.. 2018; 103:(6)F547-F553 https://doi.org/10.1136/archdischild-2017-313203

Davis J, Fairley D, Christie S, Coyle P, Tubman R, Shields MD. Human parechovirus infection in neonatal intensive care. Pediatr Infect Dis J.. 2015; 34:(2)121-124 https://doi.org/10.1097/INF.0000000000000510

Fenton-Jones M, Cannon A, Paul SP. Recognition and nursing management of sepsis in early infancy. Emerg Nurse.. 2017; 25:(6)23-29 https://doi.org/10.7748/en.2017.e1704

Fernando AMR, Heath PT, Menson EN. Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland. J Antimicrob Chemother.. 2008; 61:(3)743-745 https://doi.org/10.1093/jac/dkm543

Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med.. 2018; 6:(3)223-230 https://doi.org/10.1016/S2213-2600(18)30063-8

Congenital heart disease in children. 2016. https://tinyurl.com/yh3gc9n4 (accessed 26 March 2021)

Gray SL, Mukherjee A, Pettet GK, Paul SP. In-hospital newborn falls: should all neonates undergo neurological imaging?. Br J Hosp Med.. 2018; 79:(6) https://doi.org/10.12968/hmed.2018.79.6.353

Joint Formulary Committee. British national formulary for children (online). Ibuprofen. 2021. https://bnfc.nice.org.uk/drug/ibuprofen.html#indicationsAndDoses (accessed 29 March 2021)

Machado JR, Soave DF, da Silva MV Neonatal sepsis and inflammatory mediators. Mediators Inflamm.. 2014; 2014 https://doi.org/10.1155/2014/269681

National Institute for Health and Care Excellence. Neonatal infection (early onset): antibiotics for prevention and Treatment [CG149]. 2012. https://www.nice.org.uk/guidance/cg149 (accessed: 26 March 2021)

National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis, and early management. NG51. 2016. https://tinyurl.com/yftqx7w7 (accessed 26 March 2021)

Paul SP, Caplan EM, Morgan HA, Turner PC. Barriers to implementing the NICE guidelines for early-onset neonatal infection: cross-sectional survey of neonatal blood culture reporting by laboratories in the UK. J Hosp Infect.. 2018; 98:(4)425-428 https://doi.org/10.1016/j.jhin.2017.12.015

Paul SP, Goodman A, Remorino R, Bolger S. Newborn falls in-hospital: time to address the issue. Pract Midwife.. 2011; 14:(4)29-32

Polin RA Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics.. 2012; 129:(5)1006-1015 https://doi.org/10.1542/peds.2012-0541

Public Health England. Guidance. Newborn and infant physical examination (NIPE) screening: programme overview 2013. https://tinyurl.com/yh5ufkhc (accessed 29 March 2021)

Public Health England. Updated guidelines on post exposure prophylaxis (PEP) for varicella/shingles. 2019. https://tinyurl.com/ub4a2wxa (accessed 29 March 2021)

Roland D. Paediatric early warning scores: Holy Grail and Achilles' heel. Arch Dis Child Educ Pract Ed.. 2012; 97:(6)208-215 https://doi.org/10.1136/archdischild-2011-300976

Satar M, Ozlü F. Neonatal sepsis: a continuing disease burden. Turk J Pediatr.. 2012; 54:(5)449-457

Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev.. 2014; 27:(1)21-47 https://doi.org/10.1128/CMR.00031-13

Stoll BJ, Gordon T, Korones SB Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr.. 1996; 129:(1)63-71 https://doi.org/10.1016/S0022-3476(96)70191-9

Vergnano S, Menson E, Kennea N Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed.. 2011; 96:(1)F9-F14 https://doi.org/10.1136/adc.2009.178798

Wynn JL, Levy O. Role of innate host defenses in susceptibility to early-onset neonatal sepsis. Clin Perinatol.. 2010; 37:(2)307-337 https://doi.org/10.1016/j.clp.2010.04.001

Recognition and management of neonatal sepsis

Luke William Crocker

5th Year Medical Student, University of Bristol, Bristol

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Ayesha White

Paul Anthony Heaton

Consultant Paediatricians, Yeovil District Hospital

Débora Pascoal Horta

Ward Manager, Special Care Baby Unit, Yeovil District Hospital, Yeovil

Siba Prosad Paul

Consultant Paediatrician, Torbay Hospital, Torquay

View articles · Email Siba Prosad

Neonatal sepsis results from acute bacterial or viral infection occurring in the first 28 days of life. It causes significant morbidity and mortality, although the outcome can be improved by early recognition and prompt treatment by health professionals. This article describes the most common causes of sepsis, and explains why neonates are particularly vulnerable to infection. It highlights the non-specific way in which an infant with a serious infection may present, indicating the crucial features to elicit during history taking and examination, and emphasising the ‘red-flag’ signs and symptoms that should increase suspicion of a serious illness. The authors have adapted National Institute for Health and Care Excellence guidelines to produce an evidence-based approach to the management of an infant with suspected sepsis, and describe the roles of nurses in ensuring effective treatment and best outcomes for these babies.

Neonatal sepsis occurs when there is a serious bacterial or viral infection manifesting in the first 28 days of life (National Institute for Health and Care Excellence ( NICE) 2012 ). A systematic review with meta-analysis by Fleischmann-Struzek et al (2018) involving 23 studies estimated that it carries a mortality rate of 11–19*. The same study estimated that, globally, 3 million neonates are affected each year; the non-specific and varied nature of presentation may result in late diagnosis and delayed treatment. It is important that health professionals are aware of the condition and suspect sepsis at an early stage. This article details the clinical features of neonatal sepsis and includes two illustrative case studies to provide context.

Neonatal infections are divided into early-onset sepsis (EOS) occurring within the first 48 hours of birth, and late-onset sepsis (LOS) occurring between 2 and 28 days after birth ( Cailes et al, 2018 ). The neonatal infection surveillance network (NeonIN) study involving 12 neonatal units in England over a 10-year period recorded a total of 541 bacterial infections in 443 infants; it recorded an infection rate of 8/1000 live births, and 71/1000 in those admitted to the neonatal unit; sepsis was most common among male infants (56*) born prematurely (<37 weeks) and/or had a low birth weight <2500 g ( Vergnano et al, 2011 ).

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Predictors of early-onset neonatal sepsis in premature newborns: Case-control study

Affiliations.

• 1 Service de Néonatologie, Hôpital Louis Mourier, AP-HP, 92700, Colombes, Université Paris Didérot, Paris, France; Département de Pédiatrie, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo. Electronic address: [email protected].
• 2 Département de Pédiatrie, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo.
• 3 Service de Néonatologie, Hôpital Louis Mourier, AP-HP, 92700, Colombes, Université Paris Didérot, Paris, France.
• PMID: 35094903
• DOI: 10.1016/j.arcped.2022.01.013

Introduction: Early-onset neonatal sepsis (EOS) is difficult to diagnose clinically because the semiology of premature newborns is poor during the first days of life. This study aimed to identify predictive factors of EOS in neonates less than 37 weeks' gestational age in neonatal care at Louis Mourier Hospital, France.

Method: This was a case-control study of all newborns less than 37 weeks of gestational age diagnosed and managed for EOS from January 1 to December 31, 2019. The main parameters studied were demographic characteristics, risk factors, laboratory, and bacteriological characteristics. At the benchmarking level, the statistical tests used were the McNemar test for qualitative variables and the paired Student's t-test for quantitative variables.

Results: A total of 50 mother-child pairs were included in this study (25 cases and 25 matched controls). The results showed a statistically significant relationship between the birth of a child with EOS and between a premature rupture of membranes of > 18 h (68% of cases vs. 36% of controls; p = 0.042); a positive culture of the placenta (p = 0.0002); C-reactive protein levels of > 6 mg/L (88% of cases vs. 20% of controls; p = 0.001); a procalcitonin level of > 0.6 ng/mL (72% of cases vs. 16% of controls; p = 0.001). Gram-negative bacteria including Escherichia coli (44.5%) and Haemophilus influenzae (14.8%) were the most common pathogens found.

Conclusion: The search for risk factors must be systematic and the clinic must remain at the center of the diagnostic approach.

Keywords: Early bacterial neonatal infection; Predictive factors; Premature.

Copyright © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

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Indications and patterns of blood transfusion in neonatal intensive care unit of a tertiary hospital in north west nigeria, ibrahim usman kusfa, aisha indo mamman, ismaila nda ibrahim, augustine benjamin, garba yahaya, aisha ahmed abubakar,  sirajo mohammed aminu, abdulaziz hassan, muhammad shakir balogun.

Background: Neonates requiring intensive care are among the most frequently transfused group of patients. Indications for blood transfusion in neonates could be physiological or pathological. However, despite frequent blood transfusions in neonates in Zaria, there is a paucity of studies on its indications and patterns among neonates in our setting. Objectives: The objective of this study is to determine the indications and patterns of blood transfusions among neonates in the neonatal intensive care unit (NICU) of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Methods: This was a cross‑sectional study on neonates in the NICU of ABUTH, Zaria. A pro forma was used to collect information from the mothers and neonates’ case notes. Charts and table were used to show frequencies and proportions on the indications and types of blood transfusion given. Results: A total number of 172 neonates were admitted during the study period among whom 60 had blood transfusion. The median age (interquartile range) of the neonates was 2.5 (27) days, and the mean (± standard deviation) birth weight and hematocrit of the neonates were 2432.5 ± 722.9 g and 37.19 ± 8.76%, respectively, with 32 (53.3%) being males. Neonatal anemia (30, 50%), neonatal jaundice (25, 41.7%), neonatal sepsis (3, 5%), and preparation for surgery (2, 3.3%) were the indications for blood transfusion. Thirty‑nine (65.0%) and 21 (35.0%) of the neonates had top‑up and exchange blood transfusion, respectively. Conclusions: Neonatal anemia and jaundice were the major indications for blood transfusion while simple top-up was the main type of blood transfusions among the neonates in this study.

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Utilization of in vivo imaging system to study staphylococcal sepsis and septic arthritis progression in mouse model.

1. Introduction

2. materials and methods, 2.1. ethics statement, 2.3. bacterial strains, 2.4. mouse models of s. aureus sepsis and hematogenous septic arthritis, 2.5. antibiotic treatment in mouse model of s. aureus-induced sepsis, 2.6. mouse model of local s. aureus septic arthritis, 2.7. quantification of s. aureus infection using in vivo imaging system, 2.8. homogenate preparation and quantification of bacterial load in kidneys and joints, 2.9. quantification of immunomodulators using enzyme-linked immunosorbent assay, 2.10. bone erosion estimation using μct, 3.1. in vivo imaging systems are able to follow the progression and severity of sepsis in mice, 3.2. kidney ivis signals correlate positively with kidney abscess severity and kidney cfu counts, 3.3. the efficacy of antibiotic treatment against infection was monitored using the imaging system, 3.4. assessing clinical arthritis progression using imaging system, 3.5. imaging technique can determine the infectious progression over time in a local infection model, 4. discussion, supplementary materials, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

• Jin, T.; Mohammad, M.; Pullerits, R.; Ali, A. Bacteria and Host Interplay in Staphylococcus aureus Septic Arthritis and Sepsis. Pathogens 2021 , 10 , 158. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Singer, M.; Deutschman, C.S.; Seymour, C.W.; Shankar-Hari, M.; Annane, D.; Bauer, M.; Bellomo, R.; Bernard, G.R.; Chiche, J.D.; Coopersmith, C.M.; et al. The Third International Consensus Definitions for Sepsis and Septic Shock [Sepsis-3]. JAMA 2016 , 315 , 801–810. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Naber, C.K. Staphylococcus aureus bacteremia: Epidemiology, pathophysiology, and management strategies. Clin. Infect. Dis. 2009 , 48 (Suppl. 4), S231–S237. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• van Hal, S.J.; Jensen, S.O.; Vaska, V.L.; Espedido, B.A.; Paterson, D.L.; Gosbell, I.B. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin. Microbiol. Rev. 2012 , 25 , 362–386. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kaandorp, C.J.; Dinant, H.J.; van de Laar, M.A.; Moens, H.J.; Prins, A.P.; Dijkmans, B.A. Incidence and sources of native and prosthetic joint infection: A community based prospective survey. Ann. Rheum. Dis. 1997 , 56 , 470–475. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Weston, V.C.; Jones, A.C.; Bradbury, N.; Fawthrop, F.; Doherty, M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann. Rheum. Dis. 1999 , 58 , 214–219. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tarkowski, A. Infection and musculoskeletal conditions: Infectious arthritis. Best Pract. Res. Clin. Rheumatol. 2006 , 20 , 1029–1044. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Geirsson, A.J.; Statkevicius, S.; Víkingsson, A. Septic arthritis in Iceland 1990-2002: Increasing incidence due to iatrogenic infections. Ann. Rheum. Dis. 2008 , 67 , 638–643. [ Google Scholar ] [ CrossRef ]
• Gunnlaugsdóttir, S.L.; Erlendsdóttir, H.; Helgason, K.O.; Geirsson, Á.J.; Thors, V.; Guðmundsson, S.; Gottfreðsson, M. Native joint infections in Iceland 2003–2017: An increase in postarthroscopic infections. Ann. Rheum. Dis. 2022 , 81 , 132–139. [ Google Scholar ] [ CrossRef ]
• Kaandorp, C.J.; Van Schaardenburg, D.; Krijnen, P.; Habbema, J.D.; van de Laar, M.A. Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum. 1995 , 38 , 1819–1825. [ Google Scholar ] [ CrossRef ]
• Abram, S.G.F.; Alvand, A.; Judge, A.; Beard, D.J.; Price, A.J. Mortality and adverse joint outcomes following septic arthritis of the native knee: A longitudinal cohort study of patients receiving arthroscopic washout. Lancet Infect. Dis. 2020 , 20 , 341–349. [ Google Scholar ] [ CrossRef ]
• Mathews, C.J.; Weston, V.C.; Jones, A.; Field, M.; Coakley, G. Bacterial septic arthritis in adults. Lancet 2010 , 375 , 846–855. [ Google Scholar ] [ CrossRef ]
• Sakiniene, E.; Bremell, T.; Tarkowski, A. Addition of corticosteroids to antibiotic treatment ameliorates the course of experimental Staphylococcus aureus arthritis. Arthritis Rheum. 1996 , 39 , 1596–1605. [ Google Scholar ] [ CrossRef ]
• Fei, Y.; Wang, W.; Kwiecinski, J.; Josefsson, E.; Pullerits, R.; Jonsson, I.M.; Magnusson, M.; Jin, T. The combination of a tumor necrosis factor inhibitor and antibiotic alleviates staphylococcal arthritis and sepsis in mice. J. Infect. Dis. 2011 , 204 , 348–357. [ Google Scholar ] [ CrossRef ]
• Ali, A.; Zhu, X.; Kwiecinski, J.; Gjertsson, I.; Lindholm, C.; Iwakura, Y.; Wang, X.; Lycke, N.; Josefsson, E.; Pullerits, R.; et al. Antibiotic-killed Staphylococcus aureus induces destructive arthritis in mice. Arthritis Rheumatol. 2015 , 67 , 107–116. [ Google Scholar ] [ CrossRef ]
• Jin, T. Exploring the role of bacterial virulence factors and host elements in septic arthritis: Insights from animal models for innovative therapies. Front. Microbiol. 2024 , 15 , 1356982. [ Google Scholar ] [ CrossRef ]
• Lim, E.; Modi, K.; Christensen, A.; Meganck, J.; Oldfield, S.; Zhang, N. Monitoring tumor metastases and osteolytic lesions with bioluminescence and micro CT imaging. J. Vis. Exp. 2011 , 2775. [ Google Scholar ] [ CrossRef ]
• Cosette, J.; Ben Abdelwahed, R.; Donnou-Triffault, S.; Sautès-Fridman, C.; Flaud, P.; Fisson, S. Bioluminescence-Based Tumor Quantification Method for Monitoring Tumor Progression and Treatment Effects in Mouse Lymphoma Models. J. Vis. Exp. 2016 , 53609. [ Google Scholar ] [ CrossRef ]
• Lim, E.; Modi, K.D.; Kim, J. In vivo bioluminescent imaging of mammary tumors using IVIS spectrum. J. Vis. Exp. 2009 , 1210. [ Google Scholar ] [ CrossRef ]
• Tu, S.H.; Hsieh, Y.C.; Huang, L.C.; Lin, C.Y.; Hsu, K.W.; Hsieh, W.S.; Chi, W.M.; Lee, C.H. A rapid and quantitative method to detect human circulating tumor cells in a preclinical animal model. BMC Cancer 2017 , 17 , 440. [ Google Scholar ] [ CrossRef ]
• Vuong, C.; Kocianova, S.; Yu, J.; Kadurugamuwa, J.L.; Otto, M. Development of real-time in vivo imaging of device-related Staphylococcus epidermidis infection in mice and influence of animal immune status on susceptibility to infection. J. Infect. Dis. 2008 , 198 , 258–261. [ Google Scholar ] [ CrossRef ]
• Konjufca, V.; Miller, M.J. Imaging Listeria monocytogenes infection in vivo. Curr. Top. Microbiol. Immunol. 2009 , 334 , 199–226. [ Google Scholar ] [ CrossRef ]
• Archer, N.K.; Wang, Y.; Ortines, R.V.; Liu, H.; Nolan, S.J.; Liu, Q.; Alphonse, M.P.; Dikeman, D.A.; Mazhar, M.; Miller, R.J.; et al. Preclinical Models and Methodologies for Monitoring Staphylococcus aureus Infections Using Noninvasive Optical Imaging. Methods Mol. Biol. 2020 , 2069 , 197–228. [ Google Scholar ] [ CrossRef ]
• Hardy, J.W.; Levashova, Z.; Schmidt, T.L.; Contag, C.H.; Blankenberg, F.G. [99mTc]Annexin V-128 SPECT Monitoring of Splenic and Disseminated Listeriosis in Mice: A Model of Imaging Sepsis. Mol. Imaging Biol. 2015 , 17 , 345–354. [ Google Scholar ] [ CrossRef ]
• Ostermann, E.; Macquin, C.; Bahram, S.; Georgel, P. Use of in vivo imaging to monitor the progression of experimental mouse cytomegalovirus infection in neonates. J. Vis. Exp. 2013 , e50409. [ Google Scholar ] [ CrossRef ]
• Caine, E.A.; Osorio, J.E. In Vivo Imaging with Bioluminescent Enterovirus 71 Allows for Real-Time Visualization of Tissue Tropism and Viral Spread. J. Virol. 2017 , 91 , e01759-16. [ Google Scholar ] [ CrossRef ]
• Bernthal, N.M.; Taylor, B.N.; Meganck, J.A.; Wang, Y.; Shahbazian, J.H.; Niska, J.A.; Francis, K.P.; Miller, L.S. Combined in vivo optical and µCT imaging to monitor infection, inflammation, and bone anatomy in an orthopaedic implant infection in mice. J. Vis. Exp. 2014 , e51612. [ Google Scholar ] [ CrossRef ]
• Miller, R.J.; Crosby, H.A.; Schilcher, K.; Wang, Y.; Ortines, R.V.; Mazhar, M.; Dikeman, D.A.; Pinsker, B.L.; Brown, I.D.; Joyce, D.P.; et al. Development of a Staphylococcus aureus reporter strain with click beetle red luciferase for enhanced in vivo imaging of experimental bacteremia and mixed infections. Sci. Rep. 2019 , 9 , 16663. [ Google Scholar ] [ CrossRef ]
• Mohammad, M.; Hu, Z.; Ali, A.; Kopparapu, P.K.; Na, M.; Jarneborn, A.; Stroparo, M.d.N.; Nguyen, M.-T.; Karlsson, A.; Götz, F.; et al. The role of Staphylococcus aureus lipoproteins in hematogenous septic arthritis. Sci. Rep. 2020 , 10 , 7936. [ Google Scholar ] [ CrossRef ]
• Fatima, F.; Fei, Y.; Ali, A.; Mohammad, M.; Erlandsson, M.C.; Bokarewa, M.I.; Nawaz, M.; Valadi, H.; Na, M.; Jin, T. Radiological features of experimental staphylococcal septic arthritis by micro computed tomography scan. PLoS ONE 2017 , 12 , e0171222. [ Google Scholar ] [ CrossRef ]
• Ali, A.; Na, M.; Svensson, M.N.; Magnusson, M.; Welin, A.; Schwarze, J.C.; Mohammad, M.; Josefsson, E.; Pullerits, R.; Jin, T. IL-1 Receptor Antagonist Treatment Aggravates Staphylococcal Septic Arthritis and Sepsis in Mice. PLoS ONE 2015 , 10 , e0131645. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Ali, A.; Welin, A.; Schwarze, J.C.; Svensson, M.N.; Na, M.; Jarneborn, A.; Magnusson, M.; Mohammad, M.; Kwiecinski, J.; Josefsson, E.; et al. CTLA4 Immunoglobulin but Not Anti-Tumor Necrosis Factor Therapy Promotes Staphylococcal Septic Arthritis in Mice. J. Infect. Dis. 2015 , 212 , 1308–1316. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Mohammad, M.; Nguyen, M.T.; Engdahl, C.; Na, M.; Jarneborn, A.; Hu, Z.; Karlsson, A.; Pullerits, R.; Ali, A.; Götz, F.; et al. The YIN and YANG of lipoproteins in developing and preventing infectious arthritis by Staphylococcus aureus. PLoS Pathog. 2019 , 15 , e1007877. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Deshmukh, M.; Subhash, S.; Hu, Z.; Mohammad, M.; Jarneborn, A.; Pullerits, R.; Jin, T.; Kopparapu, P.K. Gene expression of S100a8/a9 predicts Staphylococcus aureus-induced septic arthritis in mice. Front. Microbiol. 2023 , 14 , 1146694. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Kopparapu, P.K.; Deshmukh, M.; Hu, Z.; Mohammad, M.; Maugeri, M.; Götz, F.; Valadi, H.; Jin, T. Lipoproteins Are Responsible for the Pro-Inflammatory Property of Staphylococcus aureus Extracellular Vesicles. Int. J. Mol. Sci. 2021 , 22 , 7099. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Krzyzowska, M.; Jarneborn, A.; Thorn, K.; Eriksson, K.; Jin, T. Tofacitinib Treatment in Primary Herpes Simplex Encephalitis Interferes With Antiviral Response. J. Infect. Dis. 2022 , 225 , 1545–1553. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Na, M.; Wang, W.; Fei, Y.; Josefsson, E.; Ali, A.; Jin, T. Both anti-TNF and CTLA4 Ig treatments attenuate the disease severity of staphylococcal dermatitis in mice. PLoS ONE 2017 , 12 , e0173492. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Niska, J.A.; Meganck, J.A.; Pribaz, J.R.; Shahbazian, J.H.; Lim, E.; Zhang, N.; Rice, B.W.; Akin, A.; Ramos, R.I.; Bernthal, N.M.; et al. Monitoring bacterial burden, inflammation and bone damage longitudinally using optical and μCT imaging in an orthopaedic implant infection in mice. PLoS ONE 2012 , 7 , e47397. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Nilsson, I.M.; Bremell, T.; Rydén, C.; Cheung, A.L.; Tarkowski, A. Role of the staphylococcal accessory gene regulator (sar) in septic arthritis. Infect. Immun. 1996 , 64 , 4438–4443. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gebhardt, C.; Németh, J.; Angel, P.; Hess, J. S100A8 and S100A9 in inflammation and cancer. Biochem. Pharmacol. 2006 , 72 , 1622–1631. [ Google Scholar ] [ CrossRef ]
• Tanaka, T.; Narazaki, M.; Kishimoto, T. Immunotherapeutic implications of IL-6 blockade for cytokine storm. Immunotherapy 2016 , 8 , 959–970. [ Google Scholar ] [ CrossRef ]
• Hu, Z.; Kopparapu, P.K.; Ebner, P.; Mohammad, M.; Lind, S.; Jarneborn, A.; Dahlgren, C.; Schultz, M.; Deshmukh, M.; Pullerits, R.; et al. Phenol-soluble modulin α and β display divergent roles in mice with staphylococcal septic arthritis. Commun. Biol. 2022 , 5 , 910. [ Google Scholar ] [ CrossRef ]
• Khameneh, B.; Diab, R.; Ghazvini, K.; Fazly Bazzaz, B.S. Breakthroughs in bacterial resistance mechanisms and the potential ways to combat them. Microb. Pathog. 2016 , 95 , 32–42. [ Google Scholar ] [ CrossRef ]
• Kadurugamuwa, J.L.; Sin, L.V.; Yu, J.; Francis, K.P.; Purchio, T.F.; Contag, P.R. Noninvasive optical imaging method to evaluate postantibiotic effects on biofilm infection in vivo. Antimicrob. Agents Chemother. 2004 , 48 , 2283–2287. [ Google Scholar ] [ CrossRef ]

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Deshmukh, M.; Hu, Z.; Mohammad, M.; Jin, T. Utilization of In Vivo Imaging System to Study Staphylococcal Sepsis and Septic Arthritis Progression in Mouse Model. Pathogens 2024 , 13 , 652. https://doi.org/10.3390/pathogens13080652

Deshmukh M, Hu Z, Mohammad M, Jin T. Utilization of In Vivo Imaging System to Study Staphylococcal Sepsis and Septic Arthritis Progression in Mouse Model. Pathogens . 2024; 13(8):652. https://doi.org/10.3390/pathogens13080652

Deshmukh, Meghshree, Zhicheng Hu, Majd Mohammad, and Tao Jin. 2024. "Utilization of In Vivo Imaging System to Study Staphylococcal Sepsis and Septic Arthritis Progression in Mouse Model" Pathogens 13, no. 8: 652. https://doi.org/10.3390/pathogens13080652

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Article Contents

Introduction, case report, conflict of interest statement, ethics statement.

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Perforated neonatal appendicitis mimicking necrotizing enterocolitis in a premature neonate: a case report and literature review

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Mahmoud R Manasra, Thaer Alhroob, Mohammad Marrawani, Dalia Batanje, Yahya Imran, Moatz Harahsha, Abdul-Karim Amleh, Diaa Zugayar, Perforated neonatal appendicitis mimicking necrotizing enterocolitis in a premature neonate: a case report and literature review, Journal of Surgical Case Reports , Volume 2024, Issue 7, July 2024, rjae471, https://doi.org/10.1093/jscr/rjae471

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Necrotizing enterocolitis (NEC) predominantly affects preterm infants and can mimic other conditions like acute appendicitis. Neonatal appendicitis (NA) is extremely rare, with an incidence of 0.04–0.2% and high fatality rates. Due to its rarity and resemblance to other neonatal conditions, NA diagnosis is often delayed. We report a case of a 2220-g male preterm neonate delivered at 31 + 5 weeks via urgent cesarean section due to chorioamnionitis, initially misdiagnosed with NEC but later found to have a perforated appendix. The neonate recovered well post-surgery, with the ileostomy reversed 10 weeks later. Prompt surgical intervention is crucial for NA, as it requires different management than NEC. This case underscores the importance of considering NA in preterm infants with severe abdominal symptoms and emphasizes timely surgical intervention to improve outcomes. Additionally, it supports the hypothesis that localized NEC involving the appendix may have a better prognosis than generalized NEC.

An inflammatory bowel condition called necrotizing enterocolitis (NEC) mainly affects preterm infants [ 1 ]. NEC's clinical manifestation can mimic several diseases with different aetiologies [ 1 ]. One of them is acute appendicitis. 141 occurrences of appendicitis in neonates were documented between 1905 and 2000 [ 2 ], making it the most prevalent surgical diagnostic for paediatric patients that necessitates hospital admission [ 2 ]. However, it is extremely uncommon in the neonatal age group. The reported incidence ranges from 0.04 to 0.2% [ 2–4 ]. Neonatal appendicitis (NA) has a significant fatality rate [ 3 ]. Appendiceal involvement is not found until after an exploratory procedure, as the diagnosis of NA is frequently overlooked before surgery. Some variables contribute to the delay in diagnosis, such as the disease's rarity and how similar it seems to other more prevalent newborn illnesses [ 3 ]. We report a case of perforated appendicitis in a preterm neonate presenting as NEC and successfully managed by surgery.

A 2220-g male, the second part of a dichorionic-diamniotic twin as a product of in vitro fertilization, was born by urgent cesarean section (CS) with a gestational age of 31 + 5 weeks to a 24-year-old mother. The mother was on anticoagulant and aspirin therapy due to secondary infertility. A detailed ultrasound was done in the second trimester during the antenatal screening and showed no abnormalities. The mother had gestational diabetes mellitus, which was treated with an oral hypoglycemic agent; a urinary tract infection, which was treated with an oral antibiotic; and a premature preterm rupture of membranes (PPROM) 5 days before delivery, which was complicated by chorioamnionitis. As a result, an urgent CS was performed at our hospital.

The baby was delivered with Apgar scores of 8/10 at 1 and 5 minutes. Responding to brief positive pressure ventilation, he was admitted to the Neonatal Intensive Care Unit, where, on the first day, he was put on an O2 nasal cannula for support and started on a broad spectrum of prophylactic IV antibiotics due to the positive results of the placental swab culture for Escherichia coli . On the second day, after stabilization, a lumbar puncture was done, and CSF analysis showed partially treated meningitis, and antibiotics were adjusted according to culture sensitivity.

The results of the 24-hour laboratory tests showed hyperbilirubinemia, which was managed with phototherapy, and symptomatic polycythemia, for which a partial exchange transfusion was done. The baby improved clinically through the next few days of admission; he remained hemodynamically stable on room air, and tolerated oral feeding of premature milk formula or expressed breast milk with a gradual increase and weight gain until the 8th day of admission.

On the 8th day of admission, he developed severe abdominal distension, mottled skin, and a fever of 38°C. On examination, the abdomen was distended and tense on palpation, so he was put on nil per os (NPO), a nasogastric tube was placed for decompression, blood culture, arterial blood gas (ABG), CRP, CBC, stool for occult blood, and an abdominal X-ray were requested. He was started on intravenous Vancomycin, Amikacin, and Metronidazole.

The CBC showed that the white blood cell count was 2.1 × 10 9 cells/L, the platelet count was 276 ×10 9 cells/L, and the CRP level was 5.2 mg/dl. There was no occult blood in the stool, the ABG showed mild metabolic acidosis with a lactate level of 3.46, and an abdominal X-ray showed pneumoperitoneum with increased abdominal distension ( Fig. 1 ). The decision to perform an emergent exploratory transverse laparotomy was made with a presumed diagnosis of intestinal perforation as a complication of NEC.

Preoperative abdominal X-ray: lateral decubitus view showing pneumoperitoneum (white arrows).

Intraoperative findings included viable loops of the bowel with fibrinous exudates in the right lower quadrant and an inflamed appendix with perforation on the tip ( Fig. 2 ). Following an appendectomy, an ileostomy was created on the right lower quadrant, and an orogastric tube was inserted for gastric decompression. Pathologic analysis of the appendix revealed transmural inflammation, localized infarction, and perforation.

Intraoperative findings: inflamed appendix with perforation on the tip (arrow).

He was kept NPO for 7 days, then feeding was restarted gradually with good tolerability until the day of discharge. The baby increased in weight as appropriate; thus, the ileostomy was reversed 10 weeks after the surgery.

NA had less than 50 reported cases in the last 30 years and just more than 100 over the last century, making it a very rare condition [ 5 ]. The appendix obstruction is unlikely to occur due to the low incidence of infections predisposing to lymphadenopathy of the gut, soft diet, and recumbent position, which explains NA being uncommon [ 6 ]. It is rare to observe different localizing signs in the right upper quadrant of the abdomen, such as erythema, discomfort, and lumps [ 7 ]. Preoperative diagnosis is rarely made because of the lower incidence, non-specific clinical symptoms, and infrequent localizing signs. NA was found to be more common in boys than girls (3:1), and 25–50% of the reported cases were found in preterm neonates, with a third of cases initially diagnosed as NEC [ 7 ].

The way appendicitis appears in newborns lacks specificity and shares similarities with the presentation of NEC [ 8 ]. NEC is often misdiagnosed for neonatal perforated appendicitis (NPA) during the preoperative assessment, but diagnosis is conferred intraoperatively [ 9 ]. Abdominal distension, tenderness, feeding intolerance, and fever are the most frequent findings [ 2 , 7 ]. Abdominal distension, as in our patient, was the most common reported clinical feature; according to the literature, it was reported in 89% of cases [ 7 ]. Rapid development of abdominal sepsis may be complicated by the perforation of the appendix due to a delay in diagnosis [ 8 ]. NPA is present in up to 85% of cases; pneumoperitoneum is detected in only half of them [ 7 ]. The benefit of early surgical intervention is shown by the paradoxical fact that perforation predicts much lower mortality than non-perforated patients due to timely clinical recognition [ 8 ]. An 18–28% mortality rate was reported last year’s [ 8 ].

Many pieces of literature suggest that NPA in the first weeks of life may be due to an isolated form of NEC [ 6 ]. Explaining that low immunity or sepsis (prematurity, maternal chorioamnionitis) can increase the incidence of NPA [ 6 , 9 , 10 ]. Perforation due to primary appendisitis cannot be histologically distinguished from isolated NEC appendicopathy [ 8 ]. In a healthy premature neonate without comorbid risk factors for appendicitis, it’s important to consider a localised form of NEC affecting the appendix as a potential differential diagnosis for NPA. We believe that our 8-day preterm neonate had an isolated form of NEC manifested as NPA, sparing small and large intestines, which were found to be healthy. In a recent study that reviewed four cases of NPA attributable to NEC, it was suggested that the prognosis for NEC specifically involving the appendix may be more favourable than that for nonspecific NEC affecting the intestines [11]. We believe that we add another case to the literature that can support this fact, as our patient's postoperative prognosis was good.

None declared.

The authors declare that writing and publishing this manuscript was not funded by any organization.

The study was approved by the paediatric department of H-Clinic Specialty Hospital.

A written informed consent to publish this study was obtained from the parents of the patient.

Duchon J , Barbian ME , Denning PW . Necrotizing enterocolitis . Clin Perinatol 2021 ; 48 : 229 – 50 . https://doi.org/10.1016/j.clp.2021.03.002 .

Google Scholar

Karaman A , Cavuşoğlu YH , Karaman I , et al.  Seven cases of neonatal appendicitis with a review of the English language literature of the last century . Pediatr Surg Int 2003 ; 19 : 707 – 9 . https://doi.org/10.1007/s00383-003-1030-5 .

Bence CM , Densmore JC . Neonatal and infant appendicitis . Clin Perinatol 2020 ; 47 : 183 – 96 . https://doi.org/10.1016/j.clp.2019.10.004 .

Okumuş M , Zübarioğlu AU . Neonatal and infantile appendicitis still confuses minds: report of two cases . Ann Pediatr Surg 2020 ; 16 : 23 . https://doi.org/10.1186/s43159-020-00034-y .

Schwartz KL , Gilad E , Sigalet D , et al.  Neonatal acute appendicitis: a proposed algorithm for timely diagnosis . J Pediatr Surg 2011 ; 46 : 2060 – 4 . https://doi.org/10.1016/j.jpedsurg.2011.07.018 .

Jancelewicz T , Grace K , Doug M . Neonatal appendicitis: a new look at an old zebra . J Pediatr Surg 2008 ; 43 : e1 – 5 . https://doi.org/10.1016/j.jpedsurg.2008.05.014 .

Raveenthiran V . Neonatal appendicitis (part 1): a review of 52 cases with abdominal manifestation . J Neonatal Surg 2015 ; 4 : 4 . https://doi.org/10.47338/jns.v4.157 .

Karunakara BP , Ananda Babu MN , Maiya PP , et al.  Appendicitis with perforartion in a neonate . Indian J Pediatr 2004 ; 71 : 355 – 6 . https://doi.org/10.1007/BF02724107 .

Pieterse AS , Leong ASY , Rowland R . The mucosal changes and pathogenesis of pneumatosis cystoides intestinalis . Hum Pathol 1985 ; 16 : 683 – 8 . https://doi.org/10.1016/s0046-8177(85)80152-0 .

Kalra VK , Natarajan G , Poulik J , et al.  Isolated ruptured appendicitis presenting as pneumatosis intestinalis in a premature neonate . Pediatr Surg Int 2012 ; 28 : 439 – 41 . https://doi.org/10.1007/s00383-011-3042-x .

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C-reactive protein and thrombocytopenia as essential early indicators: Subtle approach to neonatal sepsis

Ruchi kotpal.

1 Department of Microbiology, NCR Medical College, Meerut, Uttar Pradesh, India

Sonal Jindal

2 Department of Microbiology, LLRM Govt Medical College, Meerut, Uttar Pradesh, India

Introduction:

Early diagnosis of neonatal sepsis is very essential part of newborn care to prevent mortality and decrease morbidity in newborns.

The aim of this study is to correlate an increase in C-reactive protein (CRP) titre and a decrease in platelet count with an increased incidence of neonatal septicemia, for an effective subtle approach in neonatal septicemia.

Materials and Methods:

A retrospective study was conducted in the neonatal intensive care unit (NICU) of a tertiary care hospital from Jan 2022 to July 2023. Neonates admitted to the NICU with suspected sepsis were screened for sepsis. Screening was done by taking blood culture samples before administration of antibiotics, serum samples for CRP and blood samples for platelet count.

A total of 270 newborns with suspected sepsis were included in the study. Blood culture positivity was seen in 27.7 (27/75) cases. About 32.9% (89/270) of the neonates with suspected sepsis and 61.3% (46/75) neonates with confirmed sepsis had raised CRP; 32.2% (87/270) neonates with suspected sepsis and 64% (48/75) with confirmed sepsis had decreased platelet count. Both an increase in CRP and a decrease in platelets were seen in 61.3% (46/75) of confirmed cases.

Conclusion:

In our study, both raised CRP and decreased platelet count were seen in around 60% of confirmed cases of sepsis. So, CRP titre and platelet count can be used as early, rapid diagnostic markers for confirmed sepsis.

Introduction

Neonatal sepsis (NS) is a serious blood bacterial infection in children of 28 days or younger, manifested by systemic signs and symptoms of infection.[ 1 ] Early-onset neonatal sepsis (EOS) has been defined based on the age at onset, with bacteraemia or bacterial meningitis occurring at ≤72 h in infants hospitalized in the neonatal intensive care unit (NICU). Late-onset sepsis (LOS) is sepsis occurring after 72 h in NICU infants and 7 days of life in term infants, has been variably defined as occurring up to the age of <90 or 120 days, and may be caused by vertically or horizontally acquired pathogens.[ 2 , 3 ]

Newborn infants are susceptible to infections due to low innate and acquired immunity. NS may have diverse and nonspecific symptoms and signs and a delay in the diagnosis and commencement of treatment results in high morbidity and mortality rates. The case fatality rate of sepsis among neonates ranges between 25% to 65% in India.[ 4 ]

Prompt diagnosis is required to reduce neonatal mortality. Though blood culture remains the gold standard in not only identifying the infection but also giving vital information regarding antibiotic sensitivity, it takes 48–72 h to detect the organism. However, its accuracy has been questioned because of spurious positive results due to contamination and negative blood cultures in fatal generalized bacterial infections. The yield of a positive blood culture ranges from 8 to 73%, as shown in various studies.[ 5 ]

Therefore other haematological tests are required for early diagnosis and prompt action to reduce mortality among newborns. In recent years, various inflammatory markers like interleukin and haptaglobins have been evaluated for early diagnosis but they are expensive and time-consuming. Hence various cheap but reliable laboratory tests have been evaluated for the diagnosis of systemic infection in neonates.[ 6 ]

The complete blood count (CBC) with various neutrophil parameters and C-reactive protein (CRP) are the most frequently used.[ 7 ]

The present study is aimed to evaluate the role of various blood parameters like platelet count and CRP, as an early indicator of neonatal septicemia because these are simple, bedside tests, on the basis of which antibiotic therapy can be started in the neonate.

Materials and Methods

This study was conducted in the Department of Microbiology of NCR Institute of Medical Sciences Meerut from January 2022 to July 2023 to screen for early neonatal septicemia in the NICU for early prompt antimicrobial therapy and prevention. A total of 270 newborns of either sex, with suspected sepsis, were included in the study. Prematurity and very low birth weights are also important risk factors. Suspected sepsis early symptoms may include irritability, lethargy, or poor feeding. Others are respiratory distress, fever, hypothermia or hypotension with poor perfusion and shock. Diagnosis may also be suspected on the basis of laboratory findings, which may reveal hyperglycemia or hypoglycemia, acidosis or hyperbilirubinemia.[ 8 ]

Maternal factors that put neonates at risk of EOS include group B Streptococcus status, the presence of chorioamnionitis, and infant prematurity or prolonged rupture of membranes.[ 9 ]

For LOS consider the long-term use of invasive interventions, such as mechanical ventilation and intravascular catheterisation, the failure of early enteral feeding with breast milk, a prolonged duration of parenteral nutrition, hospitalisation, surgery and underlying respiratory and cardiovascular diseases.[ 10 ]

Both term and preterm neonates irrespective of the birth weight were included in the study. Neonates with prior antibiotic administration were excluded from the study. Newborns admitted to the NICU were screened for NS. Blood samples were taken for CRP estimation by nephelometry and for platelet count by automated blood counter and microscopic slide method. Also, blood samples were taken before antibiotic administration for blood culture by conventional method.

In the laboratory, a CRP level ≤5 mg/L was considered within the normal range. The range for CRP can be classified into three groups: low (CRP ≤10 mg/L), intermediate (CRP 11–100 mg/L) and high (CRP >100 mg/L).[ 11 ]

Thrombocytopenia, defined as a platelet count below 150 × 10 9 /L, is a frequent problem in NICUs. Thrombocytopenia was defined as a platelet count below 150 × 10 9 /L and was classified as mild (101–149 × 10 9 /L), moderate (51–100 × 10 9 /L), severe (21–50 × 10 9 /L) or very severe (≤20 × 10 9 /L).[ 12 ]

Blood culture that came positive was subcultured on 5% human blood agar and nutrient agar. Further isolation and antibiotic susceptibility were performed using the disc diffusion method.

Statistical analysis

Statistical analysis was done with the help of the Statistical Package for the Social Sciences (SPSS) version. Descriptive statistics was used to infer results. Positive predictive value (PPV), negative predictive value, sensitivity and specificity were used to analyse the result. Chi-square was also used for analysis.

Blood culture positivity was seen in 75 out of 270 cases (27.7%); 48 out of 75 cases were EOS and 28 out of 75 were LOS. The most common organism isolated from blood culture was Klebsiella pneumoniae . Out of 270 newborns, 168 (62.2%) were males and 102 (37.8%) were females. Others were Escherichia coli , Pseudomonas spp., Acinetobacter spp., Staphylococcus aureus , coagulase-negative Staphylococcus spp., Enterococcus spp., Candida spp. [ Figure 1 ].

Percentage of various bacterial isolates isolated from blood culture

Raised CRP was seen in 89 newborns out of 270 (32.96%). 50 out of 75 cases of confirmed sepsis had raised CRP. The positive predictive value (PPV) of CRP estimation in confirmed sepsis was 56.2%. Also, the sensitivity of CRP in predicting confirmed sepsis is 66.6% [ Table 1 ].

Evaluation of raised CRP with culture positive and negative cases

A decrease in platelet count is seen in 87 out of 270 cases (32.22%); 56 newborns with confirmed sepsis had a decrease in platelet count. PPV of thrombocytopenia in confirmed sepsis is 64.3% [ Table 2 ].

Evaluation of thrombocytopenia with culture positive and negative cases

Both an increase in CRP and a decrease in platelets are seen in 46 culture-positive cases out of 75. The sensitivity of increased CRP and decreased platelet count in culture-positive sepsis is 61.33%. Also, the negative predictive value of CRP and platelet count is 89.6% [Tables ​ [Tables3 3 and ​ and4 4 ].

Evaluation of increased CRP and thrombocytopenia with culture positive and negative cases

Sensitivity, specificity, PPV and NPV of newborn with suspected sepsis with haematological parameters

On analysis, it was found that there is no statistical difference between both EOS and LOS with increased CRP and platelet count. Almost the same number of cases in EOS and LOS had raised CRP and decreased platelet count [ Table 5 ].

Evaluation of increased CRP and thrombocytopenia with EOS and LOS

P ≤0.001 is considered statistically significant

Out of 270 newborns, 168 (62.2%) were male babies and 102 (37.8%) were female babies. Male babies contributed 62.2% of the study population. This is in accordance with the study of Fanaroff et al . who found that the incidence of sepsis is considerably higher in male newborns than female.[ 13 ]

Out of 270 babies with suspected sepsis; blood culture positivity was seen in 75 newborns. The culture positivity rate in our study was 27.7.%. This was in correlation with Manikandan et al . whose blood culture positivity was 42.51%.[ 14 ] Similarly, Arshad et al .[ 15 ] reported that 25% of cases of NS had positive blood cultures.

Also, the role of high CRP titre in predicting culture-positive sepsis was also analyzed. In our study, it was observed that the sensitivity of raised CRP in predicting confirmed sepsis is 66.6%. The sensitivity of CRP in our study was slightly less than that of Manikandan et al . whose sensitivity of CRP was 96.59%.[ 14 ] Our sensitivity was in accordance with Grzywna et al. , which showed sensitivity of CRP at 66%.[ 16 ]

In addition, the role of thrombocytopenia in predicting culture-positive sepsis was also analysed. In our study, the sensitivity of a decrease in platelets in confirmed sepsis was 74.6%. This was in accordance with Shirazi et al. , who also reported a sensitivity of 61%.[ 17 ] Anwer et al . showed sensitivity of thrombocytopenia in the early prediction of sepsis is 52.38%.[ 18 ]

The role of both increase in CRP and thrombocytopenia in predicting confirmed sepsis was also analyzed. It was found that the PPV in our study was 46%. The sensitivity of both raised CRP and decrease in platelets was 61.3%. This was in accordance with Anwer et al . in which the PPV was 53.33%.[ 18 ]

Each test used in this study had different specificity, sensitivity and positive predictive accuracy. It has demonstrated that a combination of tests increases the sensitivity, specificity and positive predictive accuracy compared with a single test for the diagnosis of NS.[ 19 , 20 , 21 ]

According to our study, the role of individual haematological tests like CRP and platelet count can be used as the sole indicator of infection, because the sensitivity and specificity of the haematological test for diagnosing sepsis are more compared to blood culture positivity. Culture positivity rate was 27.7% compared to 61% of confirmed sepsis with raised CRP and thrombocytopenia both in early diagnosis of NS.

Evaluation of increased CPR and thrombocytopenia also correlated with EOS and LOS. However, no statistically significant data could be revealed. There was no correlation between EOS and LOS with various haematological markers like CRP and platelet.

So, according to our study, simple haematological tests like CRP titres and platelet count can be used as early, rapid diagnostic markers for confirmed sepsis. Blood culture and sensitivity take 48–72 h to yield the organism grown and give a sensitivity pattern. Also, a lot of infrastructure is required to give sensitivity report. But blood parameters like total leukocyte count, CRP and platelet count are simple bedside tests yielding reports within a single day on the basis of which empirical antibiotic therapy can be initiated immediately within hours of suspected sepsis, therefore decreasing early neonatal deaths. Also, these tests can be done by simple methods like microscopy and latex agglutination tests without the requirement of bulky, expensive machines.

Blood culture is the gold standard for diagnosing NS. However, blood culture is time-consuming and can take up to 72 h to provide a definitive report. Therefore other haematological tests are required for early diagnosis and prompt action to reduce mortality among newborns. CRP and platelet count can be used as an early indicator of NS.

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