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LETTER TO EDITOR
Year : 2015  |  Volume : 4  |  Issue : 4  |  Page : 290-291

To Study the incidence and risk factors of early-onset neonatal sepsis in an out born neonatal intensive care unit of India


Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Date of Web Publication16-Oct-2015

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
P. O. Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.167414

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How to cite this article:
Al-Mendalawi MD. To Study the incidence and risk factors of early-onset neonatal sepsis in an out born neonatal intensive care unit of India. J Clin Neonatol 2015;4:290-1

How to cite this URL:
Al-Mendalawi MD. To Study the incidence and risk factors of early-onset neonatal sepsis in an out born neonatal intensive care unit of India. J Clin Neonatol [serial online] 2015 [cited 2019 Dec 13];4:290-1. Available from: http://www.jcnonweb.com/text.asp?2015/4/4/290/167414

Sir,

I have two comments on the interesting study by Jajoo et al.[1]

First, Jajoo et al. addressed that the incidence of early-onset neonatal sepsis (EONS) was 18/1000 patient. Low birth weight (68%), prematurity (46%), and poor hygiene/cord care (46%) were common risk factors while lethargy/refusal to feed (77%), hypothermia (47.5%), and respiratory distress (44%) were common clinical presentations. Sepsis screen and blood culture were positive in 57% and 18%, respectively. Klebsiella pneumonia (36%), Staphylococcus aureus (21%), and  Escherichia More Details coli (14%) were common organisms. Case fatality rate was 14%.[1] I presume that the aforementioned results should be cautiously taken owing to the presence of the following three limitations. (1) The study population was small (n = 82). (2) The study period was short (1 year). (3) There was a methodological limitation related to the diagnostic algorithm used in the study to diagnosis sepsis. Jajoo et al. employed the following work-up. Sepsis screen and cultures (blood/urine/cerebrospinal fluid), tracheal aspirate, and chest X-ray were taken prior to the administration of antibiotics. Sepsis screen included total leukocyte count (TLC) and differential count, absolute neutrophil count (ANC), C-reactive protein (CRP), and immature to total neutrophil (I/TN) ratio. Sepsis screen was considered positive when any two of the following laboratory criteria were present: TLC <5000/mm 3, I/TN ratio 0.2, ANC <1800, and positive CRP >10 mg/dL.[1] I presume that such sepsis work-up could not detect precisely all cases of EONS. This is based on the observation that the diagnosis of neonatal sepsis (NS) is a challenge due to nonspecific clinical signs and the fact that infection markers are difficult to interpret in thefirst and critical phase of NS.[2] Accordingly, I presume that significant number of newborns included in Jajoo et al.'s study [1] were either over or underdiagnosed with EONS. Precise diagnosis of NS is in progress, and the recently published diagnostic work-up has shown that 16S rDNA polymerase chain reaction assay is more sensitive than blood culture. Moreover, the combination of markers (hs-CRP, procalcitonin [PCT], and interleukin [IL-6) was better than single markers to diagnose NS. In addition, PCT had greater diagnostic value than did hs-CRP and IL-6 while IL-6 was better for diagnosis of neonatal infection.[3] I presume that constrained financial resources might curtail the implementation of the aforementioned sepsis work-up in India.

Second, Streptococcus agalactiae (SA) (previously called group B Streptococcus) is found in the digestive and vaginal tracts of 20–30% healthy individuals. It can infect the amniotic fluid before delivery or can infect the baby during delivery causing sepsis, pneumonia, or meningitis.[4] Though intrapartum antibiotic prophylaxis (IPAP) protocol employed in many parts of the world has decreased the incidence of early-onset SA infection dramatically, it still remains a major cause of NS.[5] To my knowledge, IPAP protocol is not yet widely implemented in the healthcare system in India. Hence, the nondetection of SA infection in Jajoo et al.'s study [1] is interesting and it might be attributed to the aforementioned limitations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Jajoo M, Kapoor K, Garg LK, Manchanda V, Mittal SK. To study the incidence and risk factors of early onset neonatal sepsis in an out born neonatal intensive care unit of India. J Clin Neonatol 2015;4:91-5.  Back to cited text no. 1
  Medknow Journal  
2.
Hedegaard SS, Wisborg K, Hvas AM. Diagnostic utility of biomarkers for neonatal sepsis – A systematic review. Infect Dis (Lond) 2015;47:117-24.  Back to cited text no. 2
    
3.
Al-Zahrani AK, Ghonaim MM, Hussein YM, Eed EM, Khalifa AS, Dorgham LS. Evaluation of recent methods versus conventional methods for diagnosis of early-onset neonatal sepsis. J Infect Dev Ctries 2015;9:388-93.  Back to cited text no. 3
    
4.
Six A, Joubrel C, Tazi A, Poyart C. Maternal and perinatal infections to Streptococcus agalactiae. Presse Med 2014;43 (6 Pt 1):706-14.  Back to cited text no. 4
    
5.
Shah BA, Padbury JF. Neonatal sepsis: An old problem with new insights. Virulence 2014;5:170-8.  Back to cited text no. 5
    




 

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