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Early-Onset Neonatal Sepsis and Risk Factors in the Preterm Infants

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Early-Onset Neonatal Sepsis and Risk Factors in the Preterm Infants A L J O A T U N R I N R A E L P Original Article P L E R A Perinatal Journal 2019;27(3):143–149 I N N R A U T A L J O ©2019 Perinatal Medicine Foundation Early-onset neonatal sepsis and risk factors in the preterm infants Envera Lekić İD , Sonja Babović İD , Jelena Vukićević İD , Milorada Nešović İD , Ljubinka Dragaš İD Department of Neonatology, University Clinical Center of Montenegro, Podgorica, Montenegro Abstract Özet: Preterm bebeklerde erken bafllang›çl› sepsis ve risk faktörleri Objective: The aim of the study was to identify the risk factors Amaç: Çal›flman›n amac›, preterm yenido¤an bebeklerde erken and bacterial microorganisms causing early-onset sepsis in bafllang›çl› sepsise yol açan risk faktörlerini ve bakteriyel mikro- preterm newborn infants. organizmalar› tespit etmekti. Methods: The open-label study was prospectively conducted from Yöntem: Aç›k uçlu çal›flma, Ocak–Aral›k 2015 tarihleri aras›nda January to December 2015 in the University Clinical Center, Podgorica, Karada¤’daki Üniversite Klinik Merkezi, Çocuk Has- Institute for Children’s Diseases, Center of Neonatology Podgorica, tal›klar› Enstitüsü, Neonatoloji Merkezi’nde prospektif olarak yü- Montenegro. rütüldü. Results: Out of 653 infants admitted (427 full-term, 226 preterm) the Bulgular: Çal›flmaya baflvuran 653 bebekten (427 miad, 226 pre- study included 71 infants diagnosed with sepsis (full-term infants with term), sepsis tan›s› alm›fl 71 bebek (32 sepsisli miad yenido¤an sepsis – 32 cases [7.5%] and preterm newborns with sepsis – 39 cases [%7.5] ve 39 sepsisli preterm yenido¤an [%17.3]) çal›flmaya dahil [17.3%]). Blood culture was positive in 44 newborns with sepsis (20 edildi. Sepsisli 44 yenido¤anda kan kültürü sonucu pozitifti (20 mi- full-term, 24 preterm). Out of 24 preterm infants, early-onset sepsis ad, 24 preterm). Yirmi dört preterm bebekten, erken bafllang›çl› was proven in 8 (dominant pathogen E. coli), and late-onset sepsis in sepsis 8 olguda (dominant patojen E. coli) ve geç bafllang›çl› sepsis 16 patients (dominant pathogens Klebsiella pneumoniae and 16 olguda (dominant patojenler Klebsiella pneumoniae ve Staphylococ- Staphylococcus CoN). Premature birth and low birth weight were iden- cus CoN) tespit edildi. Prematüre do¤um ve düflük do¤um a¤›rl›¤›, tified among the most common neonatal sepsis risk factors. Maternal neonatal sepsis için en yayg›n risk faktörleri olarak belirlendi. Ma- preeclampsia, premature rupture of membrane and perinatal asphyxia ternal preeklampsi, erken membran rüptürü ve perinatal asfiksi de, were also identified as significant risk factors for early-onset neonatal preterm yenido¤an bebeklerde erken bafllang›çl› neonatal sepsis sepsis in the preterm newborn infants. için önemli risk faktörleri olarak belirlendi. Conclusion: Our data suggest that premature birth and low birth Sonuç: Verilerimiz, prematüre do¤um ve düflük do¤um a¤›rl›¤›- weight are the most common sepsis risk factors together with mater- n›n, maternal preeklampsi, erken membran rüptürü ve perinatal nal preeclampsia, premature rupture of membrane and perinatal asfiksi ile birlikte sepsis için en yayg›n risk faktörleri oldu¤unu asphyxia. göstermektedir. Keywords: Neonatal sepsis, preterm newborn, early-onset sepsis, Anahtar sözcükler: Neonatal sepsis, preterm yenido¤an, erken bafl- late onset sepsis, risk factors. lang›çl› sepsis, geç bafllang›çl› sepsis, risk faktörleri. Introduction infant exposed to a potentially pathogenic organism Infections are an important cause of morbidity and will develop serious or other potentially invasive infec- [3,4] mortality in the neonatal period, particularly in tions. Neonatal sepsis is defined as a clinical syn- preterm and very low birth weight infants.[1,2] Maternal, drome in an infant 28 days of life or younger, manifest- environmental, and host factors determine which ed by systemic signs of infection and isolation of a bac- Correspondence: Envera Lekić, MD. Department of Neonatology, University Clinical Center of Montenegro, Podgorica, Montenegro. e-mail: [email protected] / Received: September 8, 2019; Accepted: December 21, 2019 Please cite this article as: Lekić E, Babović S, Vukićević J, Nešović M, Dragaš L. Early-onset neonatal sepsis and risk factors in the preterm infants. Perinatal Journal 2019;27(3):143–149. doi:10.2399/prn.19.0273004 ORCID ID: E. Lekić 0000-0002-8899-2731; S. Babović 0000-0002-1693-4380; J. Vukićević 0000-0002-1040-5920; M. Nešović 0000-0002-4535-5927; L. Dragaš 0000-0003-0558-5979 Lekić E et al. terial pathogen from blood. We classify it as early- Table 1. Clinical manifestation of neonatal sepsis. onset sepsis (EOS) and late-onset sepsis (LOS) depending on the time of onset. EOS is defined as the Clinical manifestation onset of sepsis in the first 3 days and occurs mostly by • Apnea infections acquired from mother before or during • Respiratory distress • Fever delivery, while the postnatal environment (community • Hypoxia or hospital) plays a direct role in the development of • Poor feeding [5–7] LOS. Early diagnosis of neonatal sepsis is challeng- • Lethargy ing because clinical characteristics are non-specific and • Irritability difficult to differentiate from those of non-infectious • Hypothermia etiologies (Table 1). The clinical signs at the onset of • Change in level of activity • Hypotension sepsis are discrete, nonspecific and can be associated • Vomiting with other neonatal diseases, from mild benign disor- • Diarrhea ders to serious conditions such as: respiratory distress • Jaundice syndrome (RDS), metabolic disorders, intracranial • Meconium-stained liquor hemorrhage, congenital heart diseases, and a traumat- • Convulsions ic delivery, making the diagnosis based on physical • Cyanosis examination alone difficult.[3,4] Most early-onset bacte- rial infections are non-focal except in the circumstance of respiratory distress at or shortly after birth, in which (extremely low birth weight), BW 1000–1499 g (very the chest radiograph reveals pneumonia. Focal infec- low birth weight), BW 1500–1999 g, BW 2000–2499 g tions are frequent with late-onset neonatal sepsis and and BW >2500 g. Study was approved by Ethics include otitis media, pneumonia, soft tissue infections, Committee of Clinical Center of Montenegro. urinary tract infections, septic arthritis, osteomyelitis, and peritonitis. Few infants have overt meningeal The diagnosis of sepsis was made with sepsis signs, and a high index of suspicion and examination of screening criteria. Data on the characteristics of new- the cerebrospinal fluid are required for early diagno- borns, risk factors for the onset of sepsis and their sis.[3,6,8,9] causative agents were collected on a daily basis by qual- The aim of this study was to identify the risk factors ified medical staff. All data were entered into a survey and bacterial microorganisms causing early-onset sepsis questionnaire containing the following sections: basic in preterm newborn infants. demographic data, data on risk factors (perinatal histo- ry, gestational age, birth weight, mode of delivery, pre- Methods mature rupture of membrane (PROM), maternal fever, preeclampsia, invasive diagnostic and therapeutic pro- The open-label study was prospectively conducted cedures), information on the causes of neonatal sepsis from January to December 2015 in the University and clinical manifestation of severe neonatal infections, Clinical Center, Institute for Children’s Diseases, and the results of hematological, biochemical, bacteri- Center of Neonatology Podgorica, Montenegro. ological and other tests (Table 2). During the study period, all admitted infants with clin- ical signs and symptoms of sepsis at the time of admis- Blood samples were collected from the neonates sion, or who developed sepsis during their hospitaliza- with suspected sepsis for C-reactive protein (CRP), tion were assessed with sepsis screening tool and complete blood count (CBC), and blood cultures. enrolled in the study. Enrolled patients were divided Blood was collected from a peripheral vein. into two groups: full term newborn infants (FTI) with Approximately 1 mL of blood was inoculated directly proven sepsis and preterm infants (PTI) with neonatal into blood culture medium vials and sent to clinical sepsis. Preterm newborns were divided into five sub- microbiology laboratory for cultivation and subsequent groups according to WHO criteria: BW 500–999 g processing. 144 Perinatal Journal Early-onset neonatal sepsis and risk factors in the preterm infants Statistical analysis Table 2. Collected variables. Descriptive statistics was used to describe parameters: Perinatal variables Postnatal variables frequencies, percentages, mean, median, standard devi- α Delivery mode (vaginal, Date of birth ation (SD), and range (range). A value of =0.05 was caesarian section) adopted for the level of statistical significance. To test Single or multiple births Birth weight for differences between target groups following tests Pregnancy-induced hypertension Apgar score 2 were used: Pearson’s χ test; Spearman’s rank correla- and other mother illnesses tion, one-factor ANOVA for proportions, and two-fac- Preterm premature rupture of Gestational age membranes (i.e. ≥18 h before tor ANOVA for proportions. Statistical Package for delivery) the Social Science (SPSS) version 23.0 (IBM, Armonk, Temperature prior to and Full term infant NY, USA) was used for the statistical analysis. during delivery Preterm infant BW 500–999 g Results BW 1000–1499 g BW 1500–1999 g A total of 653 neonates were admitted at Center of BW 2000–2499
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