The burden of early onset sepsis in neonates with neonatal encephalopathy

dc.contributor.authorCar, Kathleen
dc.descriptionA research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Masters of Medicine in Paediatrics
dc.description.abstractObjective: Early-onset sepsis (EOS) is a risk factor for neonatal encephalopathy, a leading cause of neonatal deaths. We evaluated the association of EOS among newborns with neonatal encephalopathy in a low-middle income setting in South Africa; and evaluated for predictors of death in newborns with EOS and neonatal encephalopathy. Methods: We undertook a retrospective study in newbornsborn from 1st January 2016 to 30th June 2018 with gestational age ≥35 weeks and/or birth weight ≥2,500 grams, who were diagnosed with neonatal encephalopathy by the attending physician. Overall, EOS (confirmed+probable) was defined as either culture-confirmed sepsis on blood and/or cerebrospinal fluid within 72 hours of birth; or in the absence of culture confirmation, a CRP >32mg/L or an immature to total neutrophil ratio (I:T) ≥ 0.3 (i.e. probable sepsis). Results: Of 10,182 hospitalized newborns, 1,027 (10.1%) were diagnosed with neonatal encephalopathy. One-hundred and eighty-one (17.6%) neonatal encephalopathy cases had EOS (confirmed+probable), including 52 (5.1%) that were culture-confirmed sepsis and 129 (12.5%) with probable sepsis. The incidence (per 1,000 live births) of EOS (confirmed+probable) in newborns with neonatal encephalopathy was 2.3 (95% CI: 2.0-2.7); including 0.22, 0.13 and 0.06 for culture-confirmed, Group B streptococcus, Klebsiella pneumoniae and Escherichia coli, respectively. The case fatality risk (CFR) of EOS (confirmed+probable) in newborns with neonatal encephalopathy was 19.3% (95% CI: 13.9-25.9). Predictors of fatal outcome in newborns with EOS(confirmed+probable) and neonatal encephalopathy included moderate or severeneonatal encephalopathy(aOR 6.79), seizures (aOR 3.46) and in-utero HIV-exposure (aOR 3.72; p<0.05 for all predictors). Conclusion: In this low-middle income African setting, EOS (confirmed+probable) was prevalent in 17.6% of neonatal encephalopathy cases. Our study highlights the need for preventative strategies against EOS as a strategy to reduce the burden of neonatal encephalopathy.
dc.facultyFaculty of Health Sciences
dc.schoolSchool of Clinical Medicine
dc.titleThe burden of early onset sepsis in neonates with neonatal encephalopathy
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