• Korean Journal of Clinical Pharmacy
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• v.28 no.1
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• pp.10-16
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• 2018

Background: Vitamin D has been associated with sepsis in pediatric and adult patients. The association with neonates is unclear. This systematic review and meta-analysis examined the effect of neonatal and maternal vitamin D levels on neonatal early-onset sepsis. Methods: We searched studies published up to November 2017 in PubMed/Medline, Embase, and the Cochrane Library databases. All studies that reported 25-hydroxyvitamin D levels in neonates with or without early-onset sepsis were included. Meta-analysis was performed using RevMan 5.3 software. Results: Four studies were eligible. The weighted mean difference of 25-hydroxyvitamin D levels in neonates with early-onset sepsis and controls was -7.27 ng/mL (95% confidence interval = -7.62, -6.92). Maternal vitamin D levels in neonates with early-onset sepsis were significantly lower than those in controls (weighted mean difference -7.24 ng/mL, 95% confidence interval -8.45, -6.03). All neonates with early onset sepsis had vitamin D deficiency (25-hydroxyvitamin D <20 ng/mL). Conclusion: Lower neonatal and maternal 25-hydroxyvitamin D levels were associated with neonatal early-onset sepsis. Vitamin D supplementation during pregnancy may be helpful to prevent neonatal early-onset sepsis. The effects of vitamin D supplementation on early-onset sepsis in neonates warrant further study.

• Pediatric Infection and Vaccine
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• v.7 no.2
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• pp.245-249
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• 2000

Listeria monocytogenes is one of the important causes of neonatal sepsis and listerial neonatal infection manifests in two forms : Early-onset sepsis syndrome, associated with spontaneous abortion, still birth, preterm labor, granulomatosis infantiseptica, respiratory distress, sepsis, hemodynamic compromise and late-onset listerosis mainly associated with meningitis. Cases of neonatal listerosis reported in Korea have been rare and all were full term newborns. We, herein, report a case of early-onset sepsis due to L. monocytogenes in a extremely low birth weight infant who were born in a critical condition and succumbed in the second day of life despite the intensive care.

• Clinical and Experimental Pediatrics
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• v.55 no.1
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• pp.11-17
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• 2012

Purpose: Early identification of neonatal sepsis is a global issue because of limitations in diagnostic procedures. The objective of this study was to compare the diagnostic accuracy of neutrophil CD64 and C-reactive protein (CRP) as a single test for the early detection of neonatal sepsis. Methods: A prospective study enrolled newborns with documented sepsis (n=11), clinical sepsis (n=12) and control newborns (n=14). CRP, neutrophil CD64, complete blood counts and blood culture were taken at the time of the suspected sepsis for the documented or clinical group and at the time of venipuncture for laboratory tests in control newborns. Neutrophil CD64 was analyzed by flow cytometry. Results: CD64 was significantly elevated in the groups with documented or clinical sepsis, whereas CRP was not significantly increased compared with controls. For documented sepsis, CD64 and CRP had a sensitivity of 91% and 9%, a specificity of 83% and 83%, a positive predictive value of 83% and 33% and a negative predictive value of 91% and 50%, respectively, with a cutoff value of 3.0 mg/dL for CD64 and 1.0 mg/dL for CRP. The area under the receiver-operating characteristic curves for CD64 index and CRP were 0.955 and 0.527 ($P$ <0.01), respectively. Conclusion: These preliminary data show that diagnostic accuracy of CD64 is superior to CRP when measured at the time of suspected sepsis, which implies that CD64 is a more reliable marker for the early identification of neonatal sepsis as a single determination compared with CRP.

• Neonatal Medicine
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• v.15 no.1
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• pp.54-60
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• 2008

Purpose : To set up an appropriate treatment plan for neonatal sepsis by investigating changes in pathogens and antibiotic sensitivities. Methods : The medical records of very low birth weight infants (VLBWI) admitted to the neonatal intensive care unit (NICU) of the Eulji University Hospital between January 2000 and June 2006 were retrospectively reviewed. The culture reports were analyzed for causative microorganisms and antibiotic sensitivities. Results : Among 164 neonates, 19 neonates (11.6%) had 26 episodes of culture-proven sepsis. Very late onset sepsis was the most common type. The dominant pathogens of sepsis included Klebsiella pneumoniae, Streptococcus spp., coagulase negative Staphylococcus and Enterobacter spp., and were mostly multi-drug resistant. Conclusion : For the appropriate treatment of neonatal sepsis, proper use of antibiotics through the periodic review and understanding of changes of the microorganisms and antimicrobial sensitivities is necessary to prevent multi-drug resistant microorganisms and to avoid excessive use of broad-spectrum empiric antibiotics.

• Clinical and Experimental Pediatrics
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• v.61 no.5
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• pp.156-159
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• 2018

Purpose: Sepsis is a major cause of neonatal morbidity and mortality. Early diagnosis is a major problem because of the lack of specific clinical signs. Therefore, a reliable diagnostic marker is needed to guide the use of antimicrobial agents. The objective of our study was to assess the value of proadrenomedullin (pro-ADM) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis. Methods: This study enrolled 60 newborn infants with sepsis proven with positive blood cultures and 30 healthy neonates. Complete blood count, C-reactive protein levels, and pro-ADM levels were obtained from all neonates. Results: The pro-ADM levels were significantly higher ($14.39{\pm}0.75nmol/L$) in the sepsis group than in the control group ($3.12{\pm}0.23nmol/L$). The optimal cutoff value for pro-ADM was 4.3 nmol/L, with a sensitivity of 93.3% and a specificity of 86.7%. The pro-ADM levels were also higher in nonsurvivors (P=0.001). Conclusion: Pro-ADM can be used as a reliable biomarker for neonatal sepsis. High pro-ADM levels were associated with mortality and could be an early indicator of disease outcome.

• Journal of Yeungnam Medical Science
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• v.5 no.2
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• pp.161-169
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• 1988

Neonatal sepsis is a frequent and important cause of morbidity and mortality in the neonatal period. This study was undertaken to observe the 55 cases of proven neonatal sepsis among 6,717 newborn infants under 4 weeks of age, admitted to the nursery of Yeungnam University Hospital from May 1, 1983 to April 30, 1988. We observed following results : 1. The morbidity rate of male(1.12%) was higher than that of female(0.44%) significantly (p<0.05). 2. The morbidity rate of prematurity(2.65%) was higher than that of full term(0.76%) significantly (p<0.05). 3. The incidence of perinatal obstetric complications in early onset neonatal sepsis was higher than that of late onset neonatal sepsis (38.5% vs 10.3%, p<0.05). 4. The common clinical manifestations were poor feeding(52.7%), jaundice(45.5%), diarrhea(30.9%) and irritability (30.9%). 5. Among the causative organisms, gram positive organisms were predominated and Staphylococcus epidermidis was the most common organism. There was no difference in the causative organisms between early onset and late onset sepsis.

• Pediatric Infection and Vaccine
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• v.30 no.1
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• pp.12-19
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• 2023

Purpose: Sepsis is the most common cause of neonatal death accounting for 30-50% of mortality annually in developing countries. This study was to determine the prognostic factors of neonatal sepsis mortality. Methods: A retrospective cohort was conducted in Dr. R. Sosodoro Djatikoesoemo Governor Hospital from April 2021 to September 2021 on 121 neonates in the neonatal intensive care unit (NICU) diagnosed with sepsis. The inclusion criteria were neonates aged 0-28 days, admitted to the NICU, and diagnosed with sepsis. The exclusion criteria were incomplete data and the presence of congenital abnormalities. A χ² test was performed on the sex, gestational age, mode of delivery, birth weight, APGAR score, birthplace, and blood culture. A normality test was performed on leukocytes, lymphocytes, neutrophils, platelets, C-reactive protein (CRP), and length of stay. Then performed a Mann-Whitney test. Results: Birth weight (P=0.038), gestational age (P=0.009), and blood culture (P=0.014) showed a significant relationship with the neonatal sepsis outcome while Mann-Whitney test showed significant differences in the platelets (P=0.018), CRP (P=0.002), and length of stay (P<0.001). Multivariate analysis showed that 3 prognostic factors associated with neonatal sepsis mortality were prematurity (odds ratio [OR], 3.906; 95% confidence interval [CI], 1.344-11.356; P=0.012), low birth weight (LBW, OR, 2.833; 95% CI, 1.030-7.790; P=0.044), and gram-negative bacteria (OR, 4.821; 95% CI, 1.018-22.842; P=0.047). Conclusions: Prematurity, LBW, and gram-negative bacteria were associated with the prognostic factors of neonatal sepsis.

• Journal of Yeungnam Medical Science
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• v.16 no.1
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• pp.60-68
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• 1999

A nationwide survey was conducted to investigate the annual occurrence rate of neonatal sepsis, maternal risk factors in neonatal sepsis, localized infection in neonates, causative organisms in nosocomial infection and the most common causative organism for neonatal sepsis in Korea. Clinical and bacteriological data wele collected from 37 neonatal units to perform retrospective review of the medical records of the newborn infants who were confirmed as having neonatal sepsis and whose blood culture was collected to isolate organisms for one year study period from January to December in 1997. 78,463 neonates were born at 37 hospital in 1997, and 20,869 neonates were admitted to the neonatal units, During this period, 772 episodes of neonatal sepsis were recorded in 517 neonates. The occurrence rate of neonatal sepsis was 0.73%(0~2.95%). Male to female ratio was 1.15:1, and 303 cases(42.1%) were born prematurely. The main pathogens of early onset of sepsis were S. aureus(20%), S. epidermidis(14.4%) and coagulase negative staphylococcus(14. 4%). Gram negative bacilli including Enterobacter spp (7.2%), E. coli(5.1%), Klepstella(4.5%), Pseudomonas(3.7%) and Enterobacter faectum(3.6%) accounted for 24.1% of sepsis. Group B beta-hemolytic streptococcus were isolated only in two cases. Common obstetric factors were PROM(21.1%), difficulty delivery(18.7%), fetal tachycardia(5.3%), chorioamnionitis(4.9%), and maternal fever(4.7%). The main pathogens of late-onset sepsis were S. aureus(22.3%), S. epidermidis(20.4%) and CONS(9.9%). There were 6 cases(1.0%) of Candida sepsis, Frequent focal infections accompanying sepsis were pneumonia(26.1%), urinary tract infection(10.5%), meningitis(8.2%), and arthritis(3.6%), S. epidermidis(22.0%) and s. aureus(21.7%) were also the most common pathogens in 373 nosocomial infection.

• Clinical and Experimental Pediatrics
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• v.57 no.10
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• pp.451-456
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• 2014

Purpose: We evaluated serum procalcitonin (PCT) as a diagnostic marker of neonatal sepsis, and compared PCT levels with C-reactive protein (CRP) levels. Methods: We retrospectively reviewed the medical records of 269 neonates with a suspected infection, admitted to Wonkwang University School of Medicine & Hospital between January 2011 and December 2012, for whom PCT and CRP values had been obtained. Neonates were categorized into 4 groups according to infection severity. CRP and PCT values were analyzed and compared, and their effectiveness as diagnostic markers was determined by using receiver operating characteristic (ROC) curve analysis. We also calculated the sensitivity, specificity, and positive, and negative predictive values. Results: The mean PCT and CRP concentrations were respectively $56.27{\pm}81.89$ and $71.14{\pm}37.17mg/L$ in the "confirmed sepsis" group; $15.64{\pm}32.64$ and $39.23{\pm}41.41mg/L$ in the "suspected sepsis" group; $9.49{\pm}4.30$ and $0.97{\pm}1.16mg/L$ in the "mild infection" group; and $0.21{\pm}0.12$ and $0.72{\pm}0.7mg/L$ in the control group. High concentrations indicated greater severity of infection (P<0.001). Five of 18 patients with confirmed sepsis had low PCT levels (<1.0 mg/L) despite high CRP levels. In the ROC analysis, the area under the curve was 0.951 for CRP and 0.803 for PCT. The cutoff concentrations of 0.5 mg/L for PCT and 1.0 mg/L for CRP were optimal for diagnosing neonatal sepsis (sensitivity, 88.29% vs. 100%; specificity, 58.17% vs. 85.66%; positive predictive value, 13.2% vs. 33.3%; negative predictive value, 98.6% vs. 100%, respectively). Conclusion: PCT is a highly effective early diagnostic marker of neonatal infection. However, it may not be as reliable as CRP.

• Clinical and Experimental Pediatrics
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• v.49 no.11
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• pp.1167-1173
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• 2006

Purpose : To evaluate various sepsis screening tests, individually and in combination, to formulate a guideline for the diagnosis of neonatal sepsis. Methods : The study was a retrospective cohort study. It took place at the neonatal intensive care unit of the Paediatric Department, Il Sin Christian Hospital, Busan, Korea, over a period of 68 months from 1st, April, 2001 to 31st, December, 2005. This study evaluated 100 neonates having clinical features of sepsis and 100 normal asymptomatic neonates and used screening tests including C-reactive protein (CRP), total leukocyte count (TLC), absolute neutrophil count (ANC), immature neutrophils to total neutrophil count ratio (I/T ratio), thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology (GAC) for the diagnosis of neontal sepsis. Results : The sensitivity of CRP and ANC was high. CRP had 86 percent sensitivity for group-A (proven sepsis) and 74 percent sensitivity for group-B (probable sepsis) and 94 percent specificity for group-A, B. ANC had sensitivity of 72 percent for group-A and 62 percent for group-B and 86 percent specificity for group-A, B. For group-A, sensitivity, specificity of GAC for polymorphs was 74 percent and 94 percent respectively. As for sensitivity, specificity of platelet count for group-A was 64 percent and 89 percent respecively. The sensitivity, specificity and predictive values (PV) of the individual tests and different test combinations were also calculated for group-A and B. Conclusion : For the detection of culture negative cases in neonatal sepsis, screening tests including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs have high sensitivity. A combination of three tests has higher sensitivity.