PREDICTORS OF MORTALITY OUTCOME IN NEONATAL SEPSIS

A prospective study was carried out to determine the predictors of outcome in neonates with sepsis admitted to neonatal care unit at Basrah Maternity and Children Hospital over six months (from the first of November 2004 till the end of April 2005). One-hundred twenty neonates were studied, sepsis was confirmed by clinical and laboratory measures. Seventy four (61.7%) neonates were males and 46 (38.3%) were females. Thirty three (27.5%) were preterm and 87 (72.5%) were full term. Sixty seven (55.8%) neonates were still alive during period of hospitalization and discharged home, while fifty three (44.2%) neonates died. Early onset sepsis was detected in 35(29.2%) neonates while late onset sepsis was detected in 85(70.8%) neonates, however, the mortality rate was higher in early onset sepsis (62.9%) compared to late onset sepsis (36.5%). The mean body weight was significantly lower in neonates who died (1.97±0.67), compared to those who survived (2.79±0.6). A significantly higher mortality rates were among premature neonates (69.7%), and those with intrauterine growth retardation (70.8%). In addition, the death rate was higher in neonates with maternal history of prolonged rupture of membrane ≥24 hours (61.5%) compared to (39.4%) in neonates with maternal history of rupture membrane of < 24 hours before labor. The clinical signs that predict high mortality were sclermic skin (94.2%), signs of dehydration (82.8%) and prolonged capillary refilling time (68%). Highest mortality was associated with positive blood culture for Pseudomonas aeruginosa and Staphylococcus aureus, where all neonates died (100%), followed by klebsiella spp. and Escherichia coli (71.1%) and (48.5%) respectively in comparison with neonates who have positive blood culture for Proteus and Enterobacter aeruginosa where only 7.9% and 11.1% of neonates died respectively. A statistically significant higher mortality was reported in neonates having thrombocytopenia, neutropenia and Creactive protein ≥10 mg / dl. Regression analysis of different neonatal and maternal variables, hematological and microbiological tests, revealed that body weight, gestational age, thrombocytopenia, neutropenia, positive blood culture for klebsiella spp., prolonged capillary refilling time, sclerma and signs of dehydration are predictive factors of the outcome of death in neonatal sepsis.