Research Article

The characteristics of neonatal sepsis in Low Birth Weight (LBW) infants at Sanglah General Hospital, Bali, Indonesia

Novita Purnamasari Assa , I Wayan Dharma Artana, I Made Kardana, Putu Junara Putra, Made Sukmawati

Novita Purnamasari Assa
Department of Pediatrics, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia. Email: dr.novita.assa@gmail.com

I Wayan Dharma Artana
Department of Pediatrics, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia

I Made Kardana
Department of Pediatrics, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia

Putu Junara Putra
Department of Pediatrics, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia

Made Sukmawati
Department of Pediatrics, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
Online First: March 19, 2020 | Cite this Article
Assa, N., Artana, I., Kardana, I., Putra, P., Sukmawati, M. 2020. The characteristics of neonatal sepsis in Low Birth Weight (LBW) infants at Sanglah General Hospital, Bali, Indonesia. Intisari Sains Medis 11(1): 172-178. DOI:10.15562/ism.v11i1.522


Backgrounds: Neonatal sepsis is a significant cause of mortality and long-term morbidity. The preterm infant has high-risk sepsis and its sequelae. Low birth weight infants were more susceptible to sepsis. Initial infections in neonates may not be identified due to non-specific symptoms and sign with the limited laboratory criteria. This study aims to describe the characteristics of neonatal sepsis in low birth weight infants in the neonatology intensive care unit of Sanglah Hospital.

Methods: A retrospective cross-sectional study was conducted among 168 infants aged zero to 28 days with birth weights <2,500 grams from May 2017 – April 2018 at Sanglah General Hospital, Bali, Indonesia using a purposive sampling technique. The inclusion criteria were sepsis infants who were hospitalized in neonatology care rooms during the study period at Sanglah General Hospital. Variables assessed in this study were sex, location and mode of delivery, birth weight, gestational age, number of parity, length of stay, the onset of sepsis, as well as the outcome. Data were analysed using SPSS version 17 for Windows.

Results: The mortality rate of sepsis in low birth weight infants was 29.8%. Most of the subjects were male (53%), location of delivery at Sanglah Hospital (60.7%), born spontaneously (51.2%), birth weight were 1500-2499 grams (58,3%) and the most gestational ages were 32-36 weeks (44,6%). Early-onset neonatal sepsis (EONS) dominates patients with neonatal sepsis, with a mean length of stay was 23.27±20.32 days. The major infection risk factor was premature rupture membrane (PRM) >24 hours (14.9%), and minor infection risk factor was gestational age <37 weeks (78%), very low birth weight (44.6%) and asphyxia (41.1%). The total blood culture positivity was 38 (22.6%) cases, and Enterococcus faecalis was the most common organism in this study.

Conclusion: The incidence and mortality of neonatal sepsis in LBW infants were still high. The importance of knowledge and awareness of pregnant women about danger signs and the risk of infection can reduce the incidence of early-onset neonatal sepsis. Prevention of healthcare-associated infections can reduce the incidence of late-onset neonatal sepsis.

References

Evina B. Clinical Manifestations and Diagnostic Criteria of Atopic Dermatitis. J Majority. 2015;4(4):23-29.

Gomella TL. Sepsis. In: Gomella TL, Cunningham MD, Eyal FG, editors. Neonatology management, prosedures, on-call problems, disease, and drugs. Seventh Edition. New York: McGraw Hill; 2013. p, 865-73.

Aminullah A. Sepsis pada bayi baru lahir. In: Kosim M, Yunanto A, Dewi R, Saroso GI, Usman A, editors. Buku Ajar Neonatologi. 1st edition. Jakarta: Badan Penerbit IDAI; 2008. p, 170-87.

World Health Organization. Neonatal and perinatal mortality: country, regional and global estimates. World Health Organization; 2006. p, 1-75.

Ministry of Health. Report on Result of National Basic Health Research (RISKESDAS) 2007. Jakarta: The National of Health Research and Development Ministry of Health of the Republic of Indonesia; 2008.

Short MA. Linking the sepsis triad of inflammation, coagulation and suppressed fibrinolysis to infants. Adv Neonat Care. 2004;4(5):258-73.

Bone RC. A Continuing evolution in our understanding of the systemic inflammatory response syndromes (SIRS) and the multiple organ dysfunction syndromes (MODS). Ann Intern Med. 1996;125(8):680-7.

Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B, Israel Neonatal Network. Pathogen-specific early mortality in very low birth weight infants with late-onset sepsis: a national survey. Clinical Infectious Diseases, 2005;40(2):218-24.

Jain NK, Jain VM, Maheshwari S. Clinical profile of neonatal sepsis. Kathmandu Univ Med J (KUMJ). 2003;1(2):117–20.

Washburn T, Medearis DN Jr, Childs B. Sex differences insusceptibility to infections. Pediatrics. 1985; 35:57–60.

Purtillo DT, Sullivan JL. Immunological basis for superior survival of females. Am J Dis Child. 1979; 133(12):1251–3.

Simiyu E. Morbidity and mortality of the low birth weight infants in newborn unit in Kenyatta National Hospital, Nairobi. East African Med J. 2004;81(7):367–74.

Sung NJ, Lee SG, Kim MJ, Kim YH, Yang S, Hwang IT, et al. The changes of Intestinal normal flora in neonates for seven days postnatally. Korean J Pediatr Gastroenterol Nutr. 2006;9(2):162–8.

Jiang Y, Kuang L, Wang H, Li L, Zhou W, Li M. The Clinical Characteristics of Neonatal Sepsis Infection in Southwest China. Intern Med. 2016;55(6):597-603.

Ringer S. Care of the extremley low birth weight infant. In: Cloherty J, Eichenwald EC, Stark AR, editor. Manual of neonatal care. Philadelphia: Lippincott Williams & Wilkins; 2008. p.78–85.

Gerdes JS. Clinicopathologic approach to the diagnosis of neonatal sepsis. Clin Perinatol. 1991;18(2):361-81.

Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of Neonatal Sepsis: A Clinical and Laboratory Challenge. Clin Chem. 2004;50(2):279–287.

Awaisu A, Sulaiman SAS, Ibrahim MIM, Saad A. Antimicrobials utilization and outcomes of neonatal sepsis among patients admitted to a University Teaching Hospital in Malaysia. Eastern Journal of Medicine. 2007;12(1):6-14.

Akhter RJ, Hoque MM, Yasmeen BHN, Chowdhury MAKA. Bacteriological profile and sensitivity pattern of neonatal sepsis. Northern International Medical College Journal. 2016;8(1):174-7.

Morrison D, Woodford N, Cookson B. Enterococci as emerging pathogens of humans. Soc Appl Bacteriol Symp Ser. 1997;26:89S-99S.

Hufnagel M, Liese C, Loescher C, Kunze M, Proempeler H, Berner R, et al. Enterococcal colonization of infants in a neonatal intensive care unit: associated predictors, risk factors and seasonal patterns. BMC Infect Dis. 2007;7:107.

Becker K, Heilmann C, Peters G. Coagulase-Negative Staphylococci. Clin Microbiol Rev. 2014;27(4):870–926

Karam G, Chastre J, Wilcox MH, Vincent JL. Antibiotic strategies in the era of multidrug resistance. Crit Care. 2016;20(1):136.

Vincent JL, Bassetti M, François B, Karam G, Chastre J, Torres A, et al. Advances in antibiotic therapy in the critically ill. Crit Care. 2016;20(1):133.


No Supplementary Material available for this article.
Article Views      : 241
PDF Downloads : 104