Sepsis or severe infections in newborns is one of the biggest causes of death in children. The overall mortality rate of sepsis in newborns reaches 18%. Sepsis can be caused by germs or bacteria, viruses, fungi, or parasites. The most significant focus is on sepsis because of bacteria or germs. The diagnosis of sepsis requires germs. If you can obtain a substitute for germ based on the baby condition and laboratory test results, let alone what can be known from the beginning, then some difficulties in developing countries can be overcome. Another benefit is the opportunity to provide antibiotics, which is the primary therapy more rapidly in cases that are also appropriate. The focus on this research is on the advanced recitation sepsis or sepsis experienced by the newborn 7-28 days.
This control case study was conducted at Queen Sirikit Institute of Child Health (QSNICH) hospital in Bangkok. Data is taken from medical documents. The subject is divided into two. Sepsis case only includes infants aged 7-28 days with positive bacterial culture results. The control group uses newborns who do not experience any infections. The variables used include risk factors, infant clinical conditions, laboratory data, and treatment provided. Statistical calculations use double logistic regression analysis. The final model search process starts with identifying all existing potentials, followed by a selection gradually by using statistical analysis. The final model obtained is also made in the score version for easy use.
At the end of the study, it appears that the incidence of advanced sepsis in this study was 1.46%. Of the more than 100 variables used at the beginning of the study, six variables were obtained as the final model. These six aspects are difficulty in drinking, abnormal heartbeat, abnormal temperatures, abnormal oxygen saturation, abnormal white blood cells, and abnormal pH. The area below the curve used to evaluate the accuracy of the final model is 95.5%. If changed to score, this model has sensitivity and specificity of 88.5% and 90.4%.
The incidence of sepsis in various studies is relatively complicated compared to the diverse definitions. Broadly, there are two versions of the limit used are 3 and 7 days. The study used a 7-day limit. In Jakarta, the continued incidence of sepsis in newborns can reach 35%.
The availability of models and score systems makes it easy for clinicians in areas with limited facilities to determine whether a baby is exposed to sepsis due to bacteria or not. This model will relatively replace the difficulty of obtaining germ facilities. The sixth aspect that comes in the final model of the study can be done in various health facilities. Of the six aspects, 4 are clinical parameters and 2 Laboratories.
In this study, it is also known that the percentage of bacteria obtained is dominated by Gram-negative bacteria that equate to reports from several other developing countries. Of all the babies inserted as subjects, nearly 80% of them received antibiotics of ampicillin. The first line of antibiotics in newborns is a group of penicillin and gentamycin.
The number of subjects used in this study was much more than some previous models, such as NOSEP score and scores by Okascharoen in 2005. In terms of variables used, researchers purposely avoided some of the more sophisticated things, such as procalcitonin and some interleukins.
Models and final scores are obtained relatively merely. With the score available, there is no need for a calculator to help calculate the likelihood that the baby is experiencing bacterial sepsis. The existence of such models is expected to help Clininers with the final goal of lowering the decay and death due to advanced sepsis of the elderly in newborns in various locations in the world.
Writers: Dominicus Husada, K. R. Chanthavanich, Uraiwan Chotigeat, Piyarat Sunttarattiwong, Chukiat Sirivichayakul, Kisana PENGSAA, Watcharee Chokejindachai, Jaranit Kaewkungwal
Link: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4875-5 (Predictive Model for Bacterial Late-Onset Neonatal Sepsis in a Tertiary Care Hospital in Thailand)
