Simplified regimens for management of neonates and young infants with severe infection when hospital admission is not possible: study protocol for a randomized, open-label equivalence trial.

BACKGROUND: In resource-limited settings, most young infants with signs of severe infection do not receive the recommended inpatient treatment with intravenous broad spectrum antibiotics for 10 days or more because such treatment is not accessible, acceptable or affordable to families. This trial was initiated in the Democratic Republic of Congo, Kenya and Nigeria to assess the safety and efficacy of simplified treatment regimens for the young infants with signs of severe infection who cannot receive hospital care. METHODS: This is a randomized, open-label equivalence trial in which 3600 young infants with signs of clinical severe infection will be enrolled. The primary outcome is treatment failure in 7 days after enrollment, which includes death or worsening of the clinical condition on any day, or no improvement in the clinical condition by day 4 of treatment. Secondary outcomes include compliance with study therapy, adverse effects due to the study drugs and relapse or death during the week after completion of treatment. DISCUSSION: The results of this study, along with ongoing studies in Pakistan and Bangladesh, will inform the development of global policy for treatment of severe neonatal infections in resource-limited settings

Simplified Regimens for Management of Neonates and Young Infants With Severe Infection When Hospital Admission Is Not Possible: Study Protocol for a Randomized, Open-label Equivalence Trial

Background: In resource-limited settings, most young infants with signs of severe infection do not receive the recommended inpatient treatment with intravenous broad spectrum antibiotics for 10 days or more because such treatment is not accessible, acceptable or affordable to families. This trial was initiated in the Democratic Republic of Congo, Kenya and Nigeria to assess the safety and efficacy of simplified treatment regimens for the young infants with signs of severe infection who cannot receive hospital care. / Methods: This is a randomized, open-label equivalence trial in which 3600 young infants with signs of clinical severe infection will be enrolled. The primary outcome is treatment failure in 7 days after enrollment, which includes death or worsening of the clinical condition on any day, or no improvement in the clinical condition by day 4 of treatment. Secondary outcomes include compliance with study therapy, adverse effects due to the study drugs and relapse or death during the week after completion of treatment. / Discussion: The results of this study, along with ongoing studies in Pakistan and Bangladesh, will inform the development of global policy for treatment of severe neonatal infections in resource-limited settings

Treatment of fast breathing in neonates and young infants with oral amoxicillin compared with penicillin-gentamicin combination: study protocol for a randomized, open-label equivalence trial.

BACKGROUND: The World Health Organization recommends hospitalization and injectable antibiotic treatment for young infants (0-59 days old), who present with signs of possible serious bacterial infection. Fast breathing alone is not associated with a high mortality risk for young infants and has been treated with oral antibiotics in some settings. This trial was designed to examine the safety and efficacy of oral amoxicillin for young infants with fast breathing compared with that of an injectable penicillin-gentamicin combination. The study is currently being conducted in the Democratic Republic of Congo, Kenya and Nigeria. METHODS/DESIGN: This is a randomized, open-label equivalence trial. All births in the community are visited at home by trained community health workers to identify sick infants who are then referred to a trial study nurse for assessment. The primary outcome is treatment failure by day 8 after enrollment, defined as clinical deterioration, development of a serious adverse event including death, persistence of fast breathing by day 4 or recurrence up to day 8. Secondary outcomes include adherence to study therapy, relapse, death between days 9 and 15 and adverse effects associated with the study drugs. Study outcomes are assessed on days 4, 8, 11 and 15 after randomization by an independent outcome assessor who is blinded to the treatment being given. DISCUSSION: The results of this study will help inform the development of policies for the treatment of fast breathing among neonates and young infants in resource-limited settings

Sensitivity of histological chorioaminionitis and premature rupture of membranes for neonatal sepsis and its risk factors

Set the sensitivity of the histopathological diagnosis of chorioamnionitis (CAMH) for early diagnosis of neonatal sepsis and the relationship between histological chorioamnionitis and premature rupture of membranes and neonatal sepsis. Materials and methods: Prospective, observational study and diagnostic test performed in the Neonatology Service of the ‘‘Dr. José Eleuterio González’’ University Hospital. Epidemiological variables were collected from mothers and newborns. The relationship between histological chorioamnionitis with premature rupture of membranes and early neonatal sepsis was established. Results: We recorded 3694 births. Of these, 122 patients were studied as potentially infected, of whom 37 patients were excluded (2 by transfer to another hospital and 35 by not finding a histopathological study of the placenta). The study included 85 newborns. Of these, 43 (50.5%) developed clinical and laboratory data of early neonatal sepsis, the rest (n = 42, 49.5%) were healthy newborns. The sensitivity of histological chorioamnionitis with premature rupture of membranes (PRM) of more than 24 h was 81% for neonatal sepsis and 51% without. The risk factors for neonatal sepsis were: Mother with infection (p < 0.001), weight <1500 g (<0.001), gestational age <28 weeks (<0.05), APGAR score <6 in 5 min (p < 0.05). Conclusions: Placental chorioamnionitis with premature rupture of membranes > 24 h has an 81% sensitivity for neonatal sepsis. A newborn with histological chorioamnionitis has a 51% sensitivity for neonatal sepsis

How Can the Microbiologist Help in Diagnosing Neonatal Sepsis?

Neonatal sepsis can be classified into two subtypes depending upon whether the onset of symptoms is before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). These definitions have contributed greatly to diagnosis and treatment by identifying which microorganisms are likely to be responsible for sepsis during these periods and the expected outcomes of infection. This paper focuses on the tools that microbiologist can offer to diagnose and eventually prevent neonatal sepsis. Here, we discuss the advantages and limitation of the blood culture, the actual gold standard for sepsis diagnosis. In addition, we examine the utility of molecular techniques in the diagnosis and management of neonatal sepsis

Gambaran Rasio Neutrofil Imatur/neutrofil Total (Rasio I/t) Pada Tersangka Sepsis Neonatorum Yang Dirawat Di Instalasi Perawatan Neonatus RSUD Arifin Achmad Provinsi Riau

Background: Neonatal sepsis is one of major cause of neonatal death in developing countries. Blood culture is gold standard to diagnose sepsis neonatorum, but it needed 3-5 days for the result. Early diagnostic and approriate treatment can reduce the mortality and morbidity of patients. Immature to total neutrophil ratio (I/T ratio) can be used as early marker for diagnosis of neonatal sepsis.Objective: This study aimed to know I/T ratio of suspected neonatal sepsis treated in the Neonatal Unit of Arifin Achmad General Hospital of Riau Province.Methods: This is study was conducted using descriptive retrospective methods during February 2015. The sample were collected by consecutive sampling. Results: We found that 97 suspected neonatal sepsis, 81,5% of whom were 0-6 days old, 56,7% were males, and 48,5% had gestational age < 37 weeks. Late onset sepsis was the highest classification of sepsis at 80% from 30 cases of neonatal sepsis. Immature to total neutrophil ratio on suspected neonatal sepsis was ≥ 0,2 (50,5%) with a median value is 0,2.Conclusion: There was a increased I/T ratio on suspected neonatal sepsis

The Relationship between Birth Weight and Neonatal Sepsis Incidence: Literature Review

Neonatal sepsis contributes as much as 75% in increasing the neonatal mortality rate that occurs first week of birth. Neonatal sepsis is characterized by entry of bacteria in the blood that can be life-threatening. Process of neonatal sepsis can occur very quickly, if not treated with adequate treatment, death can occur within 24-48 hours. Neonatal sepsis is affected by infant factors like low birth weight (LBW). LBW in neonates can be easily infected due to immature immune formation. The study used literature review methods. Literature sourced from five databases: Biomed Central, Plus One, Pubmed, Proquest and Science Direct. Search with PICOS framework 15 journals used to analyze and obtained. Results showed the incidence of neonatal sepsis with the percentage incidence of sepsis at 16.9%-77.8%. LBW is risk of developing sepsis with the highest percentage compared to other birth weight classifications. Majority of journals stated there was a significant relationship between birth weight and neonatal sepsis (p value: 0,0131-0,001). Nurses play a role in conducting&nbsp; assessment begin ranging from pregnant to the birth and give a comprehensive nursing care earlier for birth babies less than 2.500 gram. It's effort decrease incidence of neonatal sepsis. &nbsp

Hubungan Kadar Albumin Plasma Dan Gula Darah Dengan Sepsis Neonatorum

. Sepsis is the most leading cause of morbidity and mortality in neonates. In sepsis, the proinflammatory cytokines realeasing leads to disruption of plasma albumin and blood glucose levels. This study aim to analyze the relationship of plasma albumin and blood sugar levels with neonatal sepsis. Prospective observational analytic studies conducted on suspected sepsis neonates at Pediatrics Department Sub Division Neonatology RSUP Prof.Kandou Manado. Diagnosis of sepsis based on clinical symptoms and laboratory tests. Subjects are grouped into two groups of neonatal sepsis and non-neonatal sepsis group (control group). Plasma albumin and blood glucose level examined, then statistically analyzed. The statistical analysis used was Pearson Chi-Square correlation and Fisher Exact. The data were processed using SPSS 21. The results of this study indicate that hypoalbuminemia was found in 12 (75%) of 16 neonatal sepsis subject, whereas in non-neonatal sepsis only found 5 (22,7%) of 22 non-sepsis subjects. Statistically there is a highly significant difference (p=0,001). For the impaired blood glucose (both hypoglycemia or hyperglycemia) there is no significant difference between the two groups (p=0,466).Conclusion: There is a highly significant relationship between hypoalbuminemia with neonatal sepsis. There was no significant correlation between abnormal blood glucose levels with neonatal sepsis

Presentation and outcomes of early and late onset neonatal sepsis in a Nigerian Hospital

Background: Neonatal Sepsis remains a major cause of morbidity and mortality in neonates despite great advances in antimicrobial therapy and life support measures.Objectives: To compare the aetiology, risk factors, presentation and outcomes of care between early onset neonatal sepsis (EOS) and late onset neonatal sepsis (LOS).Methods: Bacterial isolates were identified using blood cultures and antibiotic susceptibility testing was done using disc diffusion method. The risk factors, clinical presentation, laboratory findings and neonatal outcomes of the babies with EOS were compared with LOS. Statistical significance was set at P &lt;0.05.Results: Neonatal Sepsis was responsible for 16% of Special Care Baby Unit (SCBU) admissions. Of the 72 babies with sepsis, 56 (77.8%) had EOS as against 16 (22.2%) who had late-onset sepsis. Low birth weight (p=0.01) and perinatal asphyxia (p=0.01) were significantly associated with EOS while for LOS, delivery outside the health facility (p=0.01) was the only significant risk factor. Respiratory distress was more significantly observed in EOS (p = 0.01). Neonatal deaths occurred in 32% of babies with EOS while all babies with culture positive LOS survived.Conclusion: Early onset neonatal sepsis is associated with high likelihood of neonatal mortality. Unsupervised delivery, birth asphyxia and low birth weight are risk factors associated with neonatal sepsis. Efforts to ensure supervised hospital delivery and improvement in neonatal resuscitation may reduce the incidence of neonatal sepsis and its attendant complications.Keywords: Onset neonatal , Nigerian Hospital

Neonatal sepsis by bacteria: a big problema for children.

Neonatal sepsis is an important but underestimated problem around the world. It is defined as disease affecting newborns ≤ 1 month of age with clinical symptoms and positive blood cultures. Infection is an important cause of morbidity and mortality during the neonatal period, despite the great improvements in intensive neonatal care and the use of extended spectrum antimicrobial agents. The incidence of this disease in developed countries is 1/1,000 in normal term neonates and 4/1,000 in preterm neonates. These values increase in low-weight preterm neonates. In developing countries, this incidence increases to 2.2-8.6/1,000 live births. Neonatal sepsis can be subdivided into early-onset neonatal sepsis and late-onset neonatal sepsis