A three year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border.

BACKGROUND: Each year an estimated four million neonates die, the majority in the first week of life. One of the major causes of death is sepsis. Proving the incidence and aetiology of neonatal sepsis is difficult, particularly in resource poor settings where the majority of the deaths occur. METHODS: We conducted a three year observational study of clinically diagnosed early onset (<7 days of age) neonatal sepsis (EONS) in infants born to mothers following antenatal care at the Shoklo Malaria Research Unit clinic in Maela camp for displaced persons on the Thailand-Myanmar border. Episodes of EONS were identified using a clinical case definition. Conventional and molecular microbiological techniques were employed in order to determine underlying aetiology. RESULTS: From April 2009 until April 2012, 187 infants had clinical signs of EONS, giving an incidence rate of 44.8 per 1000 live births (95% CI 38.7-51.5). One blood culture was positive for Escherichia coli, E. coli was detected in the cerebrospinal fluid specimen in this infant, and in an additional two infants, by PCR. Therefore, the incidence of bacteriologically proven EONS was 0.7 per 1000 live births (95% CI 0.1-2.1). No infants enrolled in study died as a direct result of EONS. CONCLUSION: A low incidence of bacteriologically proven EONS was seen in this study, despite a high incidence of clinically diagnosed EONS. The use of molecular diagnostics and nonspecific markers of infection need to be studied in resource poor settings to improve the diagnosis of EONS and rationalise antibiotic use

Individual pneumococcal serotype acquisition rates, by NPS culture/serotyping method.

<p>100 infants were included in each group; each serotype considered independently.</p>a<p>Acquisition rate per day.</p>b<p>Non-typeable pneumococcal colonisation excluded.</p

Duration of first pneumococcal carriage episode, stratified by NPS culture/serotyping method.

<p>100 infants were included in each group.</p

Comparison of NPS culture and serotyping results by processing method.

<p>1,107 nasopharyngeal swabs evaluated by both methods.</p

Infant carriage pneumococcal serotype distribution, by latex sweep serotyping.

<p>Results of culture of 8,736 swabs from 364 infants. The bars indicate the number of isolates of each serotype and the dashed lines indicate the cumulative frequency (cumulative frequency of 67% is indicated by the vertical arrows). Dark grey bars highlight PCV13 serotypes.</p

Relationship between colonisation density and agreement between WHO culture and latex sweep result.

<p>Relationship between colonisation density and agreement between WHO culture and latex sweep result.</p

Study flow diagram.

<p>* Described in detail in reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0067933#pone.0067933-Turner3" target="_blank">[8]</a>.</p