Validity of C-reactive protein (CRP) for diagnosis of neonatal sepsis

Objective: To determine the validity of C-reactive protein levels for diagnosis of neonatal sepsis. Methods: A cross sectional [Validation] study was conducted at Neonatology unit in KRL general hospital [emergency/OPD] of 7 months duration from February 2012 to August 2012. By using purposive sampling technique, 147, sample size was calculated by using WHO sample size calculator taking sensitivity 75%, specificity 95%, expected prevalence 50%, desired precision 10% and confidence level 95%. Results: Mean age of the neonates was 5.72 days + 3.86. Male patients were 81[55.1%] while 66[44.9%] were female. Neonatal sepsis was observed in 43[29.25%] and were confirmed through blood culture while 104[70.75%] were not confirmed on blood culture as neonatal sepsis. The sensitivity and specificity of CRP in diagnosis of acute neonatal sepsis was 76.92% and 53.49% respectively while it had a positive predictive value of 80% and negative predictive value of 48.94%. Over all the diagnostic accuracy of CRP in diagnosis of neonatal sepsis was 70.07%. Conclusion: CRP estimation does have a role in the diagnosis of neonatal sepsis but the test is not specific enough to be relied upon as the only indicator

Bacterial sensitivity in neonatal sepsis

To determine the bacterial sensitivity and resistance patterns to different antibiotics in neonatal sepsis. A descriptive study including indoor patients [neonates] of Department of Neonatology, Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad from March, 2009 to September, 2009. A structured Performa was used to collect the information for the baseline characteristics like age, gender, birth weight, gestational age, mode of delivery of the neonate and age of onset of illness. The sensitivity and resistance patterns were checked by standard disc diffusion method of all the organisms found with Ampicillin, Cefotaxime, ceftazidime, ceftriaxone, Amikacin, imipenam, Ofloxacin, Azetreonam and in some cases Vancomycin. The collected data was analyzed by using SPSS version 12.0. A total of 50 Neonates with blood culture proven neonatal sepsis were included in the study by consecutive sampling. 27[54%] children presented with late onset neonatal sepsis and 23 [46%] with early neonatal sepsis. The most common organism was Enterobactor [48%] followed by Escherichia coli [16%] and Klebsiella [14%]. The highest resistance of Staphylococcus aureus was with cefotaxime [80%] followed by Enterobactor [58%]. Majority of the organisms were resistant for ceftazidime [100% by Staphylococcus, 79.2% by Enterobactor, 75% by Escherichia coli and 71% by klebsiella]. Ceftriaxone was found highly resistant for most of the organism's i.e. Klebsiella [71.4%], Enterobactor [70.8%], Staphylococcus aureus [60%] and Escherichia coli [50%]. The sensitivity of the Staphylococcus with these antibiotics was almost zero, only with vancomycin with which it was 100% sensitive. Most common organisms were Enterobactor [48%] followed by Escherichia coli [16%] and Klebsiella [14%]

Empyema thoracis: a rare presentation

We present a case of spontaneous rupture into tracheohronchial tree of a large collection of pus in the during induction of anaesthesia. This event made active ventilation and oxygenation of the patient impossible till most of the pus was drained or seutioned. Prompt lateral positioning of the patient in this case the diseased lung dependant is important to prevent the healthy lung from soiling