A STUDY ON DIAGNOSIS OF NEONATAL SEPSIS IN SEPSIS SCREEN POSITIVE NEONATES BY SIMULTANEOUS TWO SITE BLOOD CULTURE SAMPLE- A PROSPECTIVE COHORT STUDY CONDUCTED AT MGMH, WARANGAL

Abstract

Background

Neonatal sepsis is a life-threatening condition characterized by systemic infection and inflammatory response in newborns. It remains a major cause of morbidity and mortality in neonates, particularly in low and middle-income countries. Early and accurate diagnosis is essential for the timely initiation of appropriate antibiotic therapy and to improve survival rates.

Materials And Methods

The present prospective cohort study was conducted on 336 neonates admitted to NICU, Department of paediatrics, Mahatma Gandhi Memorial Hospital, Warangal, for a period of 18 months. All the patients fulfilling selection criteria were explained about the details of the disease and a written informed consent was obtained before enrolment. A detailed clinical history and physical examination was carried out on patients, the clinical data of each patient was recorded in the pre-coded clinical proforma designed for the study. The blood culture samples were labeled as sample 1 and sample 2. All the data was documented and analyzed by subjecting to statistical analysis.

Results

Out of 336 babies samples collected over 18 months - Majority of babies had Both cultures negative i.e. 172 babies (51.19%) followed by 75 babies (22.32%) with both positive culture, 49 babies (14.58%) with 2nd culture positive, and finally 40 babies (11.90%) with 1^st culture positive. Distribution of cases according to culture grouping VS various risk factors was assessed. Age at time of sampling of blood culture (less than 72 hours and more than 72 hours of age), PROM, Prolonged labor, assisted ventilation, delayed enteral feeds , type of feed (breast milk vs formula feeds) carried statistical significance. Details of various micro –organisms grown in blood culture are - Both blood cultures negative did not yield any organism in 172(51%). In 38(50.66%), blood culture was positive for klebsiella, 18(24%) Acinetobacter, spp 8(10.6%) Escherichia coli, 5(6.6%), candida albicans, 3(4%), enterococcus 3(4%), pseudomonas, 0(0%). MRSA, 0(0%) citrobacter culture samples. The high positivity of klebsiella is observed in the study followed by acinetobacter, Escherichia coli, candida, enterococcus and pseudomonas. Results showing gram negative organisms are common cause for sepsis in neonatal age group.

Conclusion

From this study, The study reveals that using two simultaneous blood culture samples from different sites significantly improves the diagnostic accuracy for neonatal sepsis, reducing false-negative results and enabling early intervention. In conclusion, this study recommends simultaneous dual-site blood culture method enhances diagnostic precision for neonatal sepsis, allowing for better detection, timely intervention in sepsis screen positive neonates and overall improvement in neonatal mortality and morbidity outcomes.