Multiple vaginal examinations and early neonatal sepsis

Background: Early onset neonatal sepsis (EONS) is caused mainly by organisms present in the genital tract. Maternal risk factors increase the incidence of EONS. This study was done to find out the association between one such risk factor i.e., multiple vaginal examinations and EONS.Methods: Case control study. 114 patients with three or more vaginal examinations after rupture of membranes were taken as cases and 114 patients with less than three vaginal examinations after rupture of membranes were taken as controls. All these babies were followed up for the development of EONS.Results: Of the 114 cases, 6 babies developed EONS. None of the babies in the control group developed EONS. So, 3 or more vaginal examinations after rupture of membranes in labour is significantly associated with early onset neonatal sepsis with p-value of 0.01305.Conclusions: Multiple vaginal examinations after rupture of membranes is a risk factor for early onset neonatal sepsis.

Bacteriological Profile and Antibiotic Susceptibility Patterns in Neonatal Septicaemia in Tertiary Care Hospital

Introduction: Neonatal septicaemia has great role in morbidityand mortality among neonates. Neonatal mortality rate hasbeen reported in India as 17 per 1000 live births as per 2016-17 data. Neonatal septicaemia may be of early onset or lateonset depending of the age of the neonates. The mostcommon bacterial agents involved are Group B Streptococcus,Klebsiella pneumoniae, CoNS, Streptococcus pneumoniae,Haemophilus influenzae etc. Diagnosis is done by manymethods but the most important and absolute mode ofdiagnosis is blood culture.Aims and Objectives: The present study is done for thedetection of bacteriological profile and their antibioticsusceptibility pattern in case of neonatal septicaemia. Earlydiagnosis and specific treatment can save the lives of manyneonates who are suffering from neonatal septicaemia.Materials and Methods: The material used for the diagnosis isvenous blood of the suspected neonates. Blood culture methodis used for the diagnosis of Neonatal septicaemia. Repeatedsubculture is done on Blood agar, Nutrient agar, andMacConkey agar plates. Confirmation of organism is donethrough different biochemical tests. The antibiotic susceptibilitytesting was performed on Muller Hinton agar (MHA) by KirbyBauer disc diffusion method for bacterial isolates, as perclinical and laboratory standards institute (CLSI) guideline.Results: Total 206 cases of suspected neonatal septicaemiawere investigated in which 142 cases are found positive. Mostcommon organism isolated was Klebsiella pneumoniae(39.44%) than Staphylococcus aureus (33.8%), otherorganisms are Escherichia coli (9.86%), CoNS (8.48%),Pseudomonas (5.63%), Enterococcus (2.82%) etc. overallincidence of Gram negative organism (54.93%) was more thanGram positive organism (45.07%). As far as antibioticsensitivity pattern was concerned most of the organism were100% sensitive to imipenem, meropenem and colistin B andresistant to Ampicillin.Conclusion: Gram negative isolates were more common thanGram positive as the causative agents of neonatal sepsis. Themost common causative organism was Klebsiella pneumoniae.The other organisms isolated were Pseudomonas aeruginosa,Staphylococcus aureus, CoNS, etc. Most of the Gram negativeisolates were sensitive to Amikacin, Gentamycin, Ofloxacin andCiprofloxacin but were highly susceptible to Meropenem,Imipenem and Collistin-B. The Gram positive isolates werebetter sensitive to Amikacin, Cephalosporin, Ciprofloxacin andClindamycin but were less sensitive or resistant to Ampicillinand Erythromycin. They showed high susceptibility toTicoplanim, Linezolid, Vancomycin and Methicillin.

Evaluation of hematological parameters in early onset neonatal sepsis.

Background & Objective : Diagnosis of early onset neonatal sepsis (EONS) is always a challange to the neonatologists. So, the study evaluate role of hematological parameters in diagnosis of EONS in a teaching hospital of eastern India. Methods: Newborn, age less than 72hours, associated with risk factors or clinical diagnosis of sepsis, admitted between March 2011 and February 2013 was enrolled in this study. They were subjected to blood culture and various sepsis screen parameters like C-Reactive Protein, micro-erythrocyte sedimentation rate (Micro ESR), total leukocyte count (TLC), Immature to Total Neutrophil ratio (I:T ratio) and platelet count. Sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV) as well as P value of all the parameters were calculated considering blood culture as ‘gold standard’ for sepsis. Result: Among 238 clinically suspected cases of early onset neonatal sepsis, blood culture was positive in 90(37.8%) cases of which Klebsiella pneumoniae (45.71%) was the predominant organism. Positive CRP and Micro ESR were the most useful tests for sepsis with a high specificity of 91.89% and 90.54% respectively but sensitivity of any one was not satisfactory. Negative predictive value of the CRP, micro- ESR, I:T ratio ranges between 90.07% and 81.99% . In relation to sepsis alteration in hematological parameters were found statistically significant (P value <0.05).Conclusion: The value of the hematological tests could be used satisfactorily to rule out EONS and withheld unnecessary antibiotic treatment. Thus the tests aids in management of EONS while waiting for culture report.