• AKREM M. ATRUSHI Assistant Professor, Department of Pediatric, College of Medicine, University of Duhok, Kurdistan Region, Iraq
Keywords: Neonatal sepsis, Duhok city, A prospective case


Background: Neonatal sepsis is a major cause of death all over the world. Risk factors represent an interaction between maternal-fetal colonization and each of transplacental immunity and the defense mechanisms of the neonate. This study is to assess the epidemiological, clinical and laboratory profiles of neonates with sepsis in relation to outcome and to determine the predictors of outcome.

Subject and Methods: A prospective study included neonates with sepsis admitted to neonatal care unit. 126 neonates with features of sepsis were included with age ranged from (1-30) days. From each patient, neonatal and maternal data were collected and clinical features as well as laboratory test results of hemoglobin, platelets count. total white blood cell and absolute neutrophil count , C-reactive protein and blood culture were collected and statistically analyzed.

Results: of 126 neonates, 32 (25.39%) died while others survived. Age < 7 days was in 61.9% of all cases, 69.84% had respiratory distress syndrome, 7.93% had hypoxic ischemic encephalopathy, 60.31% were preterm, 61.9% were born vaginally and male to female ratio was 1.73:1. There is a significant relation of mortality to respiratory distress syndrome and hypoxic ischemic encephalopathy, preterm delivery, low birth weight and male gender. Vomiting, apnea, sclerema, cyanosis and tachypnea were significantly related to the mortality. Eschericia coli were the most common followed by Klebsiella sp. The highest mortality is with Acenatobacterbaumani followed by Staphylococcu aureus with a significant relation. The C reactive protein was>10 mg/dl was in higher number of neonates with sepsis who died by comparison to those who survived, with a significant relation.

Conclusions: Neonatal sepsis is still a common cause of mortality in neonates with change in the pattern of causative organisms and this requires more monitoring and periodic surveillance. There is a real need to find out the local antibiotic sensitivities of pathogens to establish an optimal empirical treatment before the results of culture and sensitivity are available.


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1. Weber MW, Carlin JB, Gatchalian S, Lehmann D, Muhe L, Mulholland EKetal. Predictors of neonatal sepsis in developing countries. Pediatric Infect Dis J 2003; 22(8):711-717.
2. Meeting report. Explore simplified antimicrobial regimens for the treatment of neonatal sepsis. WHO, Geneva 30th September- 1st October 2002;1.
3. Mathai E, Christopher U, Mathai M, Jana AK, Rose D, Bergstrom S. Is Creactive protein useful in differentiating infected from uninfected neonates among those at risk of infection?. Indian J Pediatrics 2004; 41(9):895-900.
4. Stoll BJ, kleigman RM. The fetus and the neonatal infant. In: Behrman RE, Kliegman RM, Jenson HB (ed). Nelson’s Textbook of Pediatrics. 17ed. Philadelphia. WB Saunders CO 2004; 552, 623- 639.
5. Khalid N. Neonatal infection. In: McIntosh N, Helms P, Smyth R (eds). Forfar and Arneil textbook of pediatrics. 6th ed. Philadelphia. Churchill Livingstone CO 2003; 336-343.
6. Gross M. Infection of Neonates. In: Rudolph A, Hoffman J, Rudolph C (eds). Rudolph’s Pediatrics. 20th ed. United States of America. Prentice Hall International CO 1996;530- 536.
7. Finer N. Neonatal sepsis. San Diego Journal of Pediatrics for Neonatology 2003; 15(5): 855-867.
8. Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clinical Biochemistry 2004; 50: 279-287.
9. Loo S. Neonatal Sepsis. Hawaii Journal of Pediatrics 2002; 10 (3): 49-55.
10. Isaac man D, Burke B. Utility of serum C-reactive protein for detection of occult bacterial infection in children. Archives of Pediatrics and Adolescent Medicine 2002; 156: 903-909.
11. Nuntnarumit P, Pinkaew O, Kitiwanwaichs. Predictive values of serial C-reactive protein in neonatal sepsis. J. Med Assoc Thai 2002; 85(4): 1151- 1158.
12. Ahmed Z, Ghafoor T, Waqar T, Ali S, Aziz S, Mahmud S. Diagnostics value of C-reactive protein and hematological parameters in neonatal sepsis. J Coll Physician Surgpak 2005; 15(3): 152-156.
13. Chiesa C, Pellegrini G, Panero A. C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications and infection. Clin Chemist 2003; 49(1):60-68.
14. Bassuni W, Abbag F, Asindi A. Neonatal Death in Asir region of Saudia: Experience in a referral Neonatal intensive care unit. Saudi Med J 1995; 21 (2): 16-24.
15. Koutouby A, Habibullah J. Neonatal sepsis inDubai, United Arab Emirates. J tropical pediatrics 1995; 41: 177-180.
16. Stoll B, Holman R, Schuchat A. Decline in sepsis associated Neonatal and infant death in United States, 1979 through 1994. J of Ped. 1995; 102 (2): 18-26.
17. Dawadu A, AL-Umran K, TwumDanso K. A case control study of Neonatal sepsis: Experience from Saudi Arabia. J tropical pediatrics 1997; (43): 84-88.
18. Ezechukwa CC, Ugochukwu A, Egbuonu I, Chukwuka JO. Risk Factors for neonatal mortality in a regional tertiary hospital in Nigeria. Nigerian Journal of clinical practice 2004; 7(2):50-52.
19. JumahDS ,HassanMK. Predictors of mortality outcome in neonatal sepsis. Medical Journal of Basrah University2007;25(1):11-18.
20. Radhy H. Neonatal sepsis causative agents and outcome. Thesis submitted to the Iraqi commission for medical specialization 2001; 1-36.
21. Shrestha S, Dongol Singh S, Shrestha NC, Shrestha RPB, Madhup SK. Comparision of Clinical and Laboratory Parameters in Culture Proven and Unproven Early Onset Sepsis in NICU. Kathmandu Univ Med J2013;44(4):310-314.
22. Asindi A, Bilal N, AL-shehri M, Fatinni YA, Manna N, Habeeb SM. Neonatal sepsis. Saudi Med J 1999; 20 (12): 942-946.
23. Rodriguez M, Canadiani C, Garcia J, Gutiérrez P, Sánchez F.. Morbidity and Mortality from neonatal sepsis in a tertiary care level hospital. Saludpublica de Mexico 2003; 45 (2): 90-95.
24. Schuchat A, Zywieki S, Dinsmoor M, Mercer B, Romaguera J, O'Sullivan MJet al. Risk factors and opportunities for prevention of early onset neonatal sepsis: A multicenter case-control study. Georgia J of Pediatrics 2000; 105 (1): 21-26.
25. Stoll B, Hansen N, Fanaroff A. late onset sepsis in very low Birth weight neonates: the Experience of the NICHD Neonatal Research Net work. J of pediatrics 2002; 110(2): 285-291.

26. Obi J, kafrawi M, lgancio L. Neonatal septicemia. Saudi Med J 1999; 20(6): 433-437.
27. Gebrehiwot A, Lakew W, Moges F, Moges B, Anagaw B, Unakal C et al. Predictors of positive blood culture and death among neonates with suspected neonatal sepsis in Gondar University Hospital, Northwest Ethiopia. Euro. J. Exp. Bio., 2012;2 (6):2212-2218
28. Morgan M, Ruel T, Kumar G S, Sabnis A, Kaiser S. Predictors of Neonatal Sepsis in Rural Karnataka, India. Asian Journal of Clinical Pediatrics and Neonatology 2013;1(4):73-6.
29. Sharma D, Kumar C, Pandita A, Pratap OT, Dasi T,Murki S. Bacteriological profile and clinical predictors of ESBL neonatal sepsis. J matern Fetal Neonatal Med. 2016;29(4):567-70.
30. Kayange N, Kamugisha E, Mwizamholya1 D, Jeremiah S , Mshana S. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania. BMC Pediatrics 2010; 10:39.
31. Puopolo K, Draper D, Wi S, Newman T, Zupancic J, Lieberman E et al .Estimating the Probability of Neonatal Early-Onset Infection on the Basis of Maternal Risk Factors. Pediatrics 2011;128:e1155–e1163.
32. Jaber E, AL. Zwaini k. Neonatal septicemia in the neonatal care unit in AL- Anbar governorate in Iraq. East Med. Health J 2002; 8 (4): 30-36.
33. Guida JD, Kunig AM, Leet KH, McKenzie SE, Paul DA. Platelet count and sepsis in very low birth weight neonates: is there an organism-specific response? Pediatrics 2003;111:1411-1415.
34. Dhananjay, Kumar S .Comparison Of Biochemical and Pathological Markers in Neonates with Sepsis and Neonates without Sepsis. Int J Biol Med Res. 2011; 2(4): 1131 – 1134.
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