The clinical spectrum and outcome of neonatal sepsis in a neonatal intensive care unit at a tertiary care hospital in western Nepal: January 2000 to December 2005 - A retrospective study.

Sepsis is the commonest cause of neonatal mortality. However the incidence of the latter varies with the geographical area, the socio-economic structure and various customs and practices in the perinatal period. Till date there have been no published data regarding the latter in Nepal. With the neonatal services coming of age in Nepal it becomes pertinent to study the magnitude and characteristics of the burden of neonatal sepsis. We conducted a retrospective study over a period of six years to elucidate the risk factors, clinical spectrum, diagnostic parameters and the outcome of neonatal sepsis at a tertiary care neonatal intensive care unit. In all 265 cases of suspected sepsis were screened using a panel consisting of C – reactive protein, absolute neutrophil count and immature to total neutrophil count ratio and subsequently confirmed by cultures. The cases were early onset (n=44), late onset (n=56) and nosocomial groups (n=40). The data for the intramural (n=32) and extramural (n=68) cases was analyzed separately. In all 265 neonates (male: female = 1.86:1) were screened for sepsis, out of which 183 resulted a positive screen, of which, 100 had pathogenic organisms (37.76%). Prematurity (22 to 71%) was most frequently associated with all the categories: suspect, early onset, late onset, nosocomial, irrespective of whether they were in- or out-born. The major risk factor associated with out-born babies was asepsis during labour (57.4%). Respiratory signs and symptoms were commoner in the in-borns as well as the nosocomials. The commonest complication associated with neonatal sepsis in our study was exaggeration of neonatal jaundice/hepatitis (80 to 92%). The sensitivity and specificity for C – reactive protein, immature to total neutrophil count and absolute neutrophil count were found to be 93% and 49.7%, 36% and 75.6% and 20% and 83.4% respectively. Among the culture positive neonates (n=100), 32 were in-house deliveries, and the rest were out-born. The frequency of early and late-onset sepsis was similar. In all there were 131 isolates from blood, cerebrospinal fluid and urine, out of which 38 (29.0%) were in the in-born babies. Nosocomial sepsis accounted for 44 (33.59 %) of the isolates out of both the in and out-born babies combined. The mortality (10%) and sequelae (7.5%) was higher in the nosocomial sepsis group. We observed that there is a high rate of aseptic home deliveries. Nosocomial sepsis was an important problem in the study though the outcome was not un-encouraging. There is a need for extension and intensification of the maternal and child health services in Nepal.