Diagnosis of neonatal septicemia; thinking beyond blood culture

Background: Neonatal sepsis [NS] is a major cause of neonatal admissions to hospital and mortality. This study was conducted to evaluate different methods for rapid and reliable diagnosis of NS with an aim to rationalize the use of antibiotics and stay in Neonatal Intensive Care Unit

Objectives: To compare the different available methods for rapid and reliable diagnosis of neonatal sepsis. Study design, settings and duration: This comparative study was conducted in Emergency Department of National Institute of Child Health [NICH] Karachi for the period of six months

Subjects and Methods: Neonates who were brought to the emergency department of National Institute of Child Health with suspicion of NS were clinically examined. Those, supposed to be septic were included as study population and informed written consent was taken from their parents. After this, 3 ml blood was drawn for complete blood count [CBC], blood culture, C-reactive protein [CRP], polymerase chain reaction [PCR] and neutrophilic ratio. PCR and CRP results were compared with blood culture for specificity, sensitivity, positive and negative predictive values

Results: Out of 129 neonates, 23 [17.82%] were positive for bacterial DNA by PCR method while 42 [32.55%] were positive for infection when tested for C reactive protein marker of the blood. Whereas, only 15 [11.62%] were positive by blood culture. Sensitivity and specificity of PCR were 60% and 88% while positive and negative predictive values were 39% and 94% respectively. Sensitivity and specificity of C reactive protein were 60% and 71% while positive and negative predictive values were 21% and 93% respectively

Conclusion: Our study revealed high specificity and positive predictive values of PCR suggesting that PCR is more reliable, rapid and specific adjunct of blood culture for diagnosis of NS

Hypocalcemia in jaundiced neonates receiving phototherapy

Objective: To determine the frequency of hypocalcemia in term neonates with jaundice receiving phototherapy

Methods: This was a cross sectional study conducted at Neonatal intensive care unit, National Institute of Child Health, Karachi from 1st January 2014 to 30th December 2014. A total of 123 term neonates with jaundice of either gender managed by phototherapy were enrolled in the study. Gestational age was assessed through modified Ballard scoring. Duration of phototherapy was recorded. A sample of 3 ml of blood was sent to the laboratory for serum calcium level before initiating phototherapy and after 24 hours of continued phototherapy. All the data were recorded in the preformed proforma. Data was analyzed using SPSS version 19. P value <0.05 was taken as significant

Results: The mean age of the neonates was 8.35 +/- 6.74 days .Mean gestational age at the time of birth was 39.08 +/- 1.37 weeks. Mean duration of jaundice was 2.4 +/- 1.20 days. Mean duration of phototherapy was 1.74 +/- 0.98 days. Serum calcium level before and after 24 hours of initiating phototherapy was 8.73 +/- 0.68 mg/dl and 7.47 +/- 0.82mg/dl respectively Frequency of hypocalcemia in term jaundiced neonates receiving phototherapy were observed in 22.76% [28/123]

Conclusions: The frequency of hypocalcemia is significant in the jaundiced neonates treated with phototherapy. One needs to be vigilant in dealing neonates in this context while serial monitoring for hypocalcemia and its complications should be considered in institutional policy and research priority

Pattern and outcome of neonatal ailments in a tertiary care hospital

The pattern and outcome of neonatal diseases varies not only in different geographical settings and time spans but it also changes within the same unit at different times. Moreover, it can also be used to determine the availability, utilization and effectiveness of mother and child health services in the community. To determine and correlate the pattern and outcome of neonatal ailments in a tertiary care children hospital Karachi. Descriptive observational study carried out at National Institute of Child Health Karachi from 1st February 2011 to 31st January 2012. Subjects and The data regarding the demography, diagnosis and outcome of all admitted neonates was obtained from the patient's files. The data was entered and analyzed on Statistical Package for Social Sciences 17 to find out the frequency and mortality rate of various diseases among the patients. [p value of <0.05 was taken as significant]. A total of 4747 neonates were admitted during the study period. The male to female ratio was 1:0.6. Majority [66.2%] were referred within 72 hours of birth. The major causes of admission were sepsis [29.2%], low birth weight [23.4%], birth asphyxia [11.3%], prematurity [9.8%], meconium aspiration syndrome [8.9%], neonatal jaundice [7.0%] and pneumonia [6.4%]. Almost 55.6% cases were discharged after improvement, 29.9% expired, and 12% left against medical advice [LAMA]. Sepsis and low birth weight showed strong correlation [>/= 57.81] with overall mortality rates. Sepsis and low birth weight were the major causes of death. Public awareness and use of MNCH facilities by the communities need to be further stressed to reduce neonatal mortality and morbidity. Policy message: Monitoring of high risk pregnancies at the antenatal checkups, timely referral and availability of resuscitation facilities at delivery sites must be ensured. Regular awareness workshops for health care providers and community especially mothers could also be helpful

Identification of etiological agents by LPA and PCR in childhood meningitis

Objectives: To determine the etiological agents by Latex Particle Agglutination [LPA] and Polymerase Chain Reaction [PCR] in patients admitted with Cerebrospinal Fluid [CSF] culture negative bacterial meningitis

Methods: This descriptive case series was conducted at National Institute of Child Health, Karachi from January 2010 to December 2012. Patients meeting the WHO case definition of suspected meningitis from one month to 59 months of age were included in the study. CSF examination and culture was carried out on every patient and CSF culture negative patients were enrolled. Demographic data, clinical signs and symptoms and laboratory findings were entered into the proforma. Data was analyzed using statistical package for social sciences [SPSS] version 17. P-value < 0.05 was taken as significant

Results: A total of 166 patients were included. Male were 96 and female were 76 with the male to female ratio of 1.26. The mean age of patient was +/- SD 14.6 +/- 14.5 months. The etiological agents identified by LPA were in 26/166 [15.66%] cases and the organisms were H. influenzae type b 10 cases, streptococcus pneumoniae 15 cases and meningococcus only one case respectively. The organisms identified by PCR were in 65/166 [39.15%] cases and the isolates were H. influenzae type b 16 cases, streptococcus pneumonia 48 cases and meningococcus 01 case respectively

Conclusion: LPA and PCR are superior and useful diagnostic tools in microbiology. They can be used for rapid etiological diagnosis of bacterial meningitis for the early administration of proper antibiotic

Hemorrhagic disease of the newborn: clinical presentation and response to treatment with vitamin k

1] To determine the clinical presentation of hemorrhagic disease of the newborn. 2] To assess the response to injection vitamin K in this condition. This was a descriptive, analytical study conducted from January, 2002 to December, 2002 in the National Institute of Child Health, Karachi. All patients who presented with bleeding were admitted in the neonatal unit of the National Institute of Child Health, Karachi. After sending blood for investigations, 2mg. Vitamin K was injected intravenously. In babies with continuous or profuse bleeding, fresh frozen plasma was also given. PT and APTT were repeated after 6 to 12 hours and after one week. Data collection was done by means of a proforma. Analysis was on SPSS version 8.0. 50 cases were included in the study 78% were born at home and did not receive vitamin K at birth. 72% were low birth weight. 80% were breastfed. Gastrointestinal tract, nasal mucosa and skin were the commonest sites of bleeding. PT and APTT were prolonged in all the cases. Their values improved after six hours and normalized in one week. Vitamin K deficiency causing hemorrhagic disease of the newborn is a common problem in neonates. It shows a dramatic response to vitamin K injection. It is more common in male, preterm and low birth weight babies