Clinical features of neonatal sepsis in an emergency department of a tertiary care center in Karachi, Pakistan
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Despite the high burden of neonatal sepsis in emergency departments (EDs), most studies focus on inpatient settings or post-discharge outcomes, leaving a gap in understanding infection signs within EDs. We aimed to identify early signs of neonatal sepsis in an ED of a low- or middle- income country. Methods: This retrospective cross-sectional study was conducted on neonates with sepsis who visited the Aga Khan University Hospital ED in Karachi, Pakistan, from January 1 through December 31, 2021. We collected and analyzed patient data, covering demographics, clinical presentation, laboratory findings, and outcomes, and categorized them into 4 groups: “neonatal jaundice with suspected sepsis,” “suspected sepsis,” “sepsis,” and “septic shock.” Results: Among 368 neonates with sepsis (median age, 7.0 days [interquartile range, 3.0-16.0]), 59.6% were aged 7 days or younger, 48.9% were preterm born, and 54.3% were delivered via cesarean sections. The most common presenting symptom was fever (33.7%), followed by jaundice (20.9%), vomiting or loose stools (19.6%), and dyspnea (19.3%). The septic shock group had the highest median concentrations of C-reactive protein and blood urea nitrogen, and the lowest median values of systolic blood pressure, hemoglobin concentration, and platelet count. The group also reported the highest frequencies of oxygen therapy, intubation, blood transfusion, hospitalization to the neonatal intensive care unit, and in-hospital mortality. Blood cultures were true positive in 17 (4.6%), with Staphylococcus aureus most common, followed by Klebsiella pneumoniae, Streptococcus pyogenes, and Burkholderia cepacia. Conclusion: We found that early signs of neonatal sepsis in the Pakistani ED are neonatal age (< 7 days), true positivity of blood culture, and laboratory markers. These diagnostic approaches in low- or middle-income countries can help diagnose and treat sepsis early on, in the setting of unaffordability or unavailability of more sensitive and specific diagnostic tests.
Abstract
Purpose: Despite the high burden of neonatal sepsis in emergency departments (EDs), most studies focus on inpatient settings or post-discharge outcomes, leaving a gap in understanding infection signs within EDs. We aimed to identify early signs of neonatal sepsis in an ED of a low- or middle- income country. Methods: This retrospective cross-sectional study was conducted on neonates with sepsis who visited the Aga Khan University Hospital ED in Karachi, Pakistan, from January 1 through December 31, 2021. We collected and analyzed patient data, covering demographics, clinical presentation, laboratory findings, and outcomes, and categorized them into 4 groups: “neonatal jaundice with suspected sepsis,” “suspected sepsis,” “sepsis,” and “septic shock.” Results: Among 368 neonates with sepsis (median age, 7.0 days [interquartile range, 3.0-16.0]), 59.6% were aged 7 days or younger, 48.9% were preterm born, and 54.3% were delivered via cesarean sections. The most common presenting symptom was fever (33.7%), followed by jaundice (20.9%), vomiting or loose stools (19.6%), and dyspnea (19.3%). The septic shock group had the highest median concentrations of C-reactive protein and blood urea nitrogen, and the lowest median values of systolic blood pressure, hemoglobin concentration, and platelet count. The group also reported the highest frequencies of oxygen therapy, intubation, blood transfusion, hospitalization to the neonatal intensive care unit, and in-hospital mortality. Blood cultures were true positive in 17 (4.6%), with Staphylococcus aureus most common, followed by Klebsiella pneumoniae, Streptococcus pyogenes, and Burkholderia cepacia. Conclusion: We found that early signs of neonatal sepsis in the Pakistani ED are neonatal age (< 7 days), true positivity of blood culture, and laboratory markers. These diagnostic approaches in low- or middle-income countries can help diagnose and treat sepsis early on, in the setting of unaffordability or unavailability of more sensitive and specific diagnostic tests.