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2002 ; 58
(2
): 138-42
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NEWER CONCEPTS AND MANAGEMENT OF NEONATAL SEPSIS
#MMPMID27365677
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; Mathai S
Med J Armed Forces India
2002[Apr]; 58
(2
): 138-42
PMID27365677
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Despite extensive research into its patho-physiology, investigations and
treatment, sepsis remains an important cause of neonatal morbidity and mortality.
The incidence in developing countries is 10 times that in the developed world. A
large number of pro-and anti-inflammatory cytokines (interleukins, eicosanoids,
tumour necrosis factor-alpha, nitric oxide) have been identified, the interplay
of which leads to the Systemic Inflammatory Response Syndrome (SIRS) which can
have devastating consequences on all systems of the body. In India the common
organisms include Staphylococcus, E coli, Klebsiella and Candida. A number of
maternal and neonatal risk factors have been identified. The initial signs and
symptoms are subtle and can easily be missed. Early investigations and screening
tests are important and a promising number of new tests are being studied. The
gold standard for diagnosis is a positive culture from a body fluid or local
source in the presence of SIRS. The threshold for starting antibiotics should be
low in high-risk neonates and broad spectrum antibiotics covering the likely
organisms should be given intravenously in all suspected cases in a hospital
setting. This should be continued for at least 24-48 hours (till negative reports
are available) in suspected cases and for 2-3 weeks in proven cases. Prophylaxis
is aimed at preventing nosocomial and cross infections. Strict hand-washing,
meticulous asepsis protocols, identification of high risk groups and prompt and
better screening tests are essential in controlling this problem.