Challenges in the Diagnosis & Management of Neonatal Sepsis
DOI:
https://doi.org/10.46858/vimshsj.8409Keywords:
Neonatal sepsis, Newborns, NICU, AntibioticsAbstract
Neonatal sepsis is the main cause of neonatal mortality and a major public health problem, especially in underdeveloped countries. Although recent medical services have improved neonatal care, but still challenges remain in the diagnosis and management of neonatal infections. The diagnosis of neonatal sepsis is complicated by the frequent presence of non-infectious conditions that resemble sepsis, especially in preterm infants, and by the absence of optimal diagnostic tests. Since neonatal sepsis is a high-risk disease, especially in preterm infants, clinicians are compelled to empirically start antibiotics to infants with risk factors with and without signs of suspected sepsis. Unfortunately, both broad-spectrum antibiotics and prolonged treatment with empirical antibiotics are associated with adverse outcomes and increase antimicrobial resistance rates. Given the high incidence and mortality of sepsis in preterm infants and its long-term consequences on growth and development, efforts to reduce the rates of infection in this vulnerable population are one of the most important interventions in neonatal care. In this review, we discuss the most common questions and challenges in the diagnosis and management of neonatal sepsis, with a focus on developing countries.
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Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, Apfel H, Iannarone M, Phillips B, Lofgren KT, Sandar L. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014 Sep 13;384(9947):957-79.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. The lancet. 2012 Jun 9;379(9832):2151-61.
Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why?. The lancet. 2005 Mar 5;365(9462):891-900.
Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. The Pediatric infectious disease journal. 2009 Jan 1;28(1):S3-9.
Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatric Clinics. 2013 Apr 1;60(2):367-89.
Levy O. Innate immunity of the newborn: basic mechanisms and clinical correlates. Nature Reviews Immunology. 2007 May;7(5):379-90.
Malek A, Sager R, Kuhn P, Nicolaides KH, Schneider H. Evolution of maternofetal transport of immunoglobulins during human pregnancy. American journal of reproductive immunology. 1996 Nov;36(5):248-55.
Stephens BE, Vohr BR. Neurodevelopmental outcome of the premature infant. Pediatric Clinics. 2009 Jun 1;56(3):631-46.
Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, Higgins RD, National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. Jama. 2004 Nov 17;292(19):2357-65.
Oeser C, Lutsar I, Metsvaht T, Turner MA, Heath PT, Sharland M. Clinical trials in neonatal sepsis. Journal of Antimicrobial Chemotherapy. 2013 Dec 1;68(12):2733-45.
Ganatra HA, Zaidi AK. Neonatal infections in the developing world. InSeminars in perinatology 2010 Dec 1 (Vol. 34, No. 6, pp. 416-425). WB Saunders.
Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. The Lancet. 2005 Mar 26;365(9465):1175-88.
Zaidi AK, Thaver D, Ali SA, Khan TA. Pathogens associated with sepsis in newborns and young infants in developing countries. The Pediatric infectious disease journal. 2009 Jan 1;28(1):S10-8.
Downie L, Armiento R, Subhi R, Kelly J, Clifford V, Duke T. Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics—systematic review and meta-analysis. Archives of disease in childhood. 2013 Feb 1;98(2):146-54.
Shane AL, Stoll BJ. Neonatal sepsis: progress towards improved outcomes. Journal of Infection. 2014 Jan 1;68:S24-32.
Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. The Lancet. 2008 Jan 12;371(9607):135-42.
Opiyo N, English M. What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A systematic review. Archives of disease in childhood. 2011 Nov 1;96(11):1052-9.
Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, Mannan I, Rahman SM, Shah R, Saha SK, Syed U. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. The lancet. 2008 Jun 7;371(9628):1936-44.
Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. The lancet. 1999 Dec 4;354(9194):1955-61.
Neal PR, Kleiman MB, Reynolds JK, Allen SD, Lemons JA, Yu PL. Volume of blood submitted for culture from neonates. Journal of Clinical Microbiology. 1986 Sep;24(3):353-6.
Dietzman DE, Fischer GW, Schoenknecht FD. Neonatal Escherichia coli septicemia—bacterial counts in blood. The Journal of pediatrics. 1974 Jul 1;85(1):128-30.
Kellogg JA, Ferrentino FL, Goodstein MH, Liss J, Shapiro SL, Bankert DA. Frequency of low level bacteremia in infants from birth to two months of age. The Pediatric infectious disease journal. 1997 Apr 1;16(4):381-5.
Schelonka RL, Chai MK, Yoder BA, Hensley D, Brockett RM, Ascher DP. Volume of blood required to detect common neonatal pathogens. The Journal of pediatrics. 1996 Aug 1;129(2):275-8.
Wiswell TE, Hachey WE. Multiple site blood cultures in the initial evaluation for neonatal sepsis during the first week of life. The Pediatric infectious disease journal. 1991 May 1;10(5):365-9.
Sarkar S, Bhagat I, DeCristofaro JD, Wiswell TE, Spitzer AR. A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis. Journal of Perinatology. 2006 Jan;26(1):18-22.
Yager P, Edwards T, Fu E, Helton K, Nelson K, Tam MR, Weigl BH. Microfluidic diagnostic technologies for global public health. Nature. 2006 Jul;442(7101):412-8.
Pammi M, Flores A, Leeflang M, Versalovic J. Molecular assays in the diagnosis of neonatal sepsis: a systematic review and meta-analysis. Pediatrics. 2011 Oct 1;128(4):e973-85.
Liu CL, Ai HW, Wang WP, Chen L, Hu HB, Ye T, Zhu XH, Wang F, Liao YL, Wang Y, Ou G. Comparison of 16S rRNA gene PCR and blood culture for diagnosis of neonatal sepsis. Archives de Pédiatrie. 2014 Feb 1;21(2):162-9.
Hornik CP, Benjamin DK, Becker KC, Benjamin Jr DK, Li J, Clark RH, Cohen-Wolkowiez M, Smith PB. Use of the complete blood cell count in early-onset neonatal sepsis. The Pediatric infectious disease journal. 2012 Aug;31(8):799.
Hornik CP, Benjamin DK, Becker KC, Benjamin Jr DK, Li J, Clark RH, Cohen-Wolkowiez M, Smith PB. Use of the complete blood cell count in late-onset neonatal sepsis. The Pediatric infectious disease journal. 2012 Aug;31(8):803.
Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics. 1998 Oct 1;102(4):e41-.
Pourcyrous M, Bada HS, Korones SB, Baselski V, Wong SP. Significance of serial C-reactive protein responses in neonatal infection and other disorders. Pediatrics. 1993 Sep 1;92(3):431-5.
Meem M, Modak JK, Mortuza R, Morshed M, Islam MS, Saha SK. Biomarkers for diagnosis of neonatal infections: A systematic analysis of their potential as a point-of-care diagnostics. Journal of global health. 2011 Dec;1(2):201.
Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, De Curtis M. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clinica Chimica Acta. 2011 May 12;412(11-12):1053-9.
Downie L, Armiento R, Subhi R, Kelly J, Clifford V, Duke T. Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics—systematic review and meta-analysis. Archives of disease in childhood. 2013 Feb 1;98(2):146-54.
Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, Smith M, Escobar GJ. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011 Nov 1;128(5):e1155-63.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh W. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002 Aug 1;110(2):285-91.
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, Bizzarro MJ, Goldberg RN, Frantz ID, Hale EC, Shankaran S. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011 May 1;127(5):817-26.
Muller-Pebody B, Johnson AP, Heath PT, Gilbert RE, Henderson KL, Sharland M, iCAP Group (Improving Antibiotic Prescribing in Primary Care. Empirical treatment of neonatal sepsis: are the current guidelines adequate?. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2011 Jan 1;96(1):F4-8.
Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, Robinson MJ, Collinson A, Heath PT. Neonatal infections in England: the NeonIN surveillance network. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2011 Jan 1;96(1):F9-14.
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