[Incidence of sepsis in neonates with indirect hyperbilirubinemia in Shohadaye Tajrish hospital]

ABSTRACT

Jaundice is one of the common problems in neonates and may lead to some irreversible complications. 60% of term and 80% of preterm neonates during first week of their life are icteric which mostly are due to indirect and physiologic hyperbilirubinemia. This problem could have some important pathologic causes, such as sepsis. Because of the high referral rate of neonates with jaundice and suspicion of bacteremia and sepsis, this research conducted to determine the rate of bacteremia and causative microorganisms in Shohadaye Tajrish hospital. This study was based on patient's records. All patients were fullterm [>37 weeks] newborn with age of <28 days and birth weight of >2500 g with chief complaint of indirect hyperbilirubinemia without any symptoms of sepsis that were admitted in Shohadaye Tajrish hospital during years 2002-2003. Neonates with symptoms of sepsis and direct hyperbilirubinemia were excluded. Positive blood cultures confirmed sepsis. During the period of this study, 394 neonates were admitted due to hyperbilirubinemia and 201 cases had the criteria of research. 153 cases had positive blood culture and 21 [13.7%] had bacteremia but in second blood culture of these neonates, 5 cases had positive blood culture and only in 2 cases the same bacteria were grown and in 3 other cases different bacteria were detected in sepsis work up, 2.8% had erythrocyte sedimentation rate more than 15, C-Reactive Protein [CRP] was 1+ in 3.6% of patients, 2+ in 1.2% of patients, 3+ in 0.6% of patients. In 94.5%, CRP was negative, the serum levels of bilirubin in 14.9% were less than 15, 54.7% between 15 and 20, and in 30/4% were more than 20. 97.4% had jaundice on the first week of life, 4% were Glucose-6-phosphate dehydrogenase deficient, 18.9% had ABO incompatibility, and 8.4% had Rh blood group incompatibility. Cause of jaundice in 67.8% was unknown. There was no positive urine culture in suprapubic specimen, but in 17% of patients' urine culture were positive in urine bag specimen. It seems that bacteremia and sepsis without any clinical symptom [other than direct hyperbilirubinemia] is unlikely to happen and sepsis work up can cause excessive sampling, and sometimes lead to misdiagnosis