INTRODUCTION

Neonatal sepsis is a significant cause of morbidity and mortality, particularly among preterm infants, and remains a pressing global health concern. Early-onset neonatal sepsis is particularly challenging to diagnose due to its nonspecific clinical presentation, necessitating effective and timely diagnostic tools to reduce adverse outcomes. Traditional methods, such as microbial cultures, are slow and often unavailable in resource-limited settings. This study aimed to develop a robust multivariable risk prediction model tailored to improve early detection of Early Onset Sepsis (EOS) among preterm infants in the Philippines.

We conducted a retrospective analysis at a tertiary hospital in the Philippines using data from 1,354 preterm infants admitted between January 2019 and June 2024. Logistic regression models were employed, and predictors were selected through reverse stepwise elimination. Two scoring methods were developed: one based on beta coefficients divided by standard errors and another standardized to a total score of 100. The models were validated using Receiver Operator Characteristic curve analysis.

Version 1 of the scoring model demonstrated an Area Under the Curve (AUC) of 0.991, with a sensitivity of 90.91% and a specificity of 98.10%. Version 2 achieved an AUC of 0.999, with a sensitivity of 96.4% and a specificity of 92.44%.

The developed models provide a reliable, region specific tool for early detection of neonatal sepsis. Further validation across diverse populations and the integration of emerging diagnostic technologies, such as biomarkers and artificial intelligence, are warranted to enhance their applicability and accuracy.

Neonatal sepsis is one of the major life-threatening diseases in neonates, with significant regional variations in mortality. The Subspecialty Group of Neonatology, Society of Pediatrics, Chinese Medical Association, together with the Editorial Board of the Chinese Journal of Contemporary Pediatrics, organized neonatology experts to integrate the latest advances in clinical research on neonatal sepsis. Taking into account the current situation of primary healthcare institutions in China, they addressed nine common clinical questions regarding the diagnosis, treatment, and referral of neonatal sepsis for primary healthcare providers, and resulting in 19 expert consensus recommendations. This consensus aims to help primary healthcare providers promptly identify neonatal sepsis, ensure timely intervention or referral, and improve clinical outcomes.
Humans ; Infant, Newborn ; Neonatal Sepsis/therapy* ; Primary Health Care ; Consensus

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34⁺⁰ weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.
Infant ; Infant, Newborn ; Humans ; Birth Weight ; Intensive Care Units, Neonatal ; Retrospective Studies ; Tertiary Care Centers ; Infant, Extremely Low Birth Weight ; Gestational Age ; Infant, Extremely Premature ; Sepsis/epidemiology* ; Retinopathy of Prematurity/epidemiology* ; Bronchopulmonary Dysplasia/epidemiology*

Background: Neonatal sepsis contributes to significant morbidity and mortality. Blood culture, the gold standard in its diagnosis, has low sensitivity and is affected by multiple factors. Hence the need for markers derived from routine tests to improve diagnosis deserves further studies. Objectives: This study aims to determine the association and optimal cut-off value and diagnostic performance of absolute neutrophil count (ANC) and neutrophil lymphocyte ratio (NLR) with early-onset neonatal sepsis in term neonates. Methodology: This was a retrospective, analytical, single-center study of admitted patients from January 2016 to December 2021. Clinical factors were analyzed and NLR and ANC were derived from CBC and interpreted using the Manroe chart. Results: Included were 200 neonates with a median birth AOG of 38 weeks. Microorganisms were isolated from nine of 154 neonates with blood culture, corresponding prevalence of 5.84% (95% CI 2.71–10.80). Initial CBC showed elevated mean WBC and 76.5% of neonates were considered to have elevated ANC. Optimal cut-off point of NLR for detecting culture-proven sepsis was 2.86, with a sensitivity of 88.89% (95% CI, 51.75–99.72%) and specificity of 36.55% (95% CI, 28.72–44.95%). The ANC gave the best balance of sensitivity and specificity with an accuracy of 75.50%. Conclusions The NLR demonstrated good discriminative ability for predicting clinical neonatal sepsis based on ANC. However, individually or simultaneously, these markers demonstrated poor discriminative ability for culture-proven neonatal sepsis in term neonates. ANC and NLR can be used to aid in the diagnosis of clinical neonatal sepsis.
Neonatal Sepsis

Background: Early-onset sepsis (EOS) is a leading cause of morbidity and mortality among neonates. Diagnosis of EOS can be difficult as clinical signs are subtle. The use of the Neonatal EOS Calculator (NEOSC) may help screen high-risk neonates for EOS and may result in a significant reduction in unnecessary antibiotic use. Objective: To determine the diagnostic accuracy of the NEOSC in screening for EOS in neonates more than 35 weeks age of gestation. Methodology: This was a retrospective, case-control study where 245 septic (cases) and 245 non-septic (controls) neonatal and maternal medical records were reviewed. The EOS risk classification from the NEOSC was compared with the actual clinical outcome. An online statistical software (medcalc.org) was used to compute for the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and accuracy of the NEOSC. Results: Based on the NEOSC, only 64 of 245 clinically septic neonates were truly positive for sepsis while 181 were falsely negative for sepsis. Of the 245 non-septic neonates, 3 were falsely positive for sepsis, while 242 were truly negative for sepsis. With a 95% confidence interval, the computed variables showed a Sn 26.12%, Sp 98.78%, PPV 76.12%, NPV 89.95%, PLR 21.33, and NLR 0.75. The accuracy of the NEOSC is 89.33%. Conclusion The NEOSC had poor sensitivity and is not recommended in screening for EOS in neonates more than 35 weeks age of gestation. It may be used as an adjunct in EOS diagnosis due to its high specificity and accuracy.
Neonatal Sepsis

Hernia of the cord (HOC) is a rare condition that results from failure of the viscera to return to the abdominal cavity by the 10th week of fetal development. It sometimes presents together with a patent omphalomesenteric duct (POMD), another rare condition, which occurs earlier in fetal development. A proportion of POMD cases may also have ileal prolapse (IP) through the POMD lumen. Neonates diagnosed with the combination of these rare clinical conditions require immediate surgical intervention to resect the POMD and non-viable bowel segments, reduce the hernia, and repair the umbilical defect. In this case series, we report two neonates diagnosed with HOC with POMD and IP. One patient who had complete IP was not fit for immediate surgery and died of respiratory distress and sepsis. The other patient had a successful surgical correction of the congenital defects, but succumbed to sepsis postoperatively. Treatment of patients with this combination of clinical conditions should focus mainly on both surgical correction, and infection control and management.
Hernia, Umbilical ; Neonatal Sepsis

Introduction: One in every three preventable under-five deaths occur in the neonatal period and one of the leading causes of neonatal death in Low and Middle-Income Countries (LMIC) is sepsis. Organisms isolated varies between and within geographical locations, its trend changes with time. Each setting hence needs to have its antibiogram for susceptible isolates to optimize treatment outcome, the background on which this study was conducted. Methodology: A retrospective study was done on neonates admitted to the Neonatal Intensive Care Unit of Bowen University Teaching Hospital, a missionary hospital in South West Nigeria, between January 2016 and December 2017. The medical records of these neonates were retrieved from the comprehensive electronic database for all neonates admitted into the unit. Result: Of the 129 newborns eligible for the study, early-onset sepsis (56.6%) predominated. There were 79 (61%) males giving a M:F ratio of 1.6:1. The incidence rate of neonatal sepsis was 15 per 1,000 live births with a mortality rate of 24%. Gram-Negative Bacilli were mostly isolated in positive cultures. The likelihood of getting a positive culture was unrelated to the age and sex of patients at presentation. There was a varying resistance pattern of the isolates to commonly used empiric antibiotics. Conclusion and Recommendation Gram-Negative Bacilli was the commonest cause of neonatal sepsis in our center, associated with poor outcome. The high incidence of resistance to the commonly used empirical treatment calls for an urgent review of practice if the trend of high morbidity and mortality would be curtailed, as well as improved infection control practices.
Neonatal Sepsis ; Microbial Sensitivity Tests

Background: Early administration of colostrum is beneficial because of the number of its immunologic components. The problem with very low birthweight (VLBW) patients is the establishment of early, tolerated, and sustained feeding. The study aimed to determine if early initiation of colostrum through oropharyngeal administration within the first hour of life reduces the risk of late-onset sepsis (LOS) among VLBW newborns. Methods: In this single-blinded randomized control trial, 84 VLBW infants with pediatric aging equal to greater than 28 weeks requiring oxygen support were enrolled. They were allocated to receive either pasteurized colostrum via oropharyngeal administration (treatment group) or none (control group). The occurrence of LOS, duration of ventilator use and oxygen support, time to reach full feeds, length of NICU stay, the occurrence of NEC, and mortality were documented. Results: A significantly greater proportion of patients who developed LOS were noted in the control group (n=38 (90.4%)) than in the treatment group (n=30 (71.4%)) (p=0.013). The use of colostrum, had a protective effect for LOS (RR=0.77; 95% CI=0.63-0.94). There were no significant differences in the secondary outcomes. Still, there was a trend towards a lower proportion of mortality (p=0.08), shorter duration of ventilator use (p=0.24) and oxygen support (p=0.17), shorter time to reach full feeds (p=0.30), and shorter NICU stay (p=0.33) in the treatment group. Conclusion Patients given pasteurized colostrum had significantly less occurrence of LOS. The treatment group had a lower mortality rate, shorter ventilator use and oxygen support duration, faster time to reach full feeds, and shorter NICU stay, but the differences were not statistically significant. Oropharyngeal administration of pasteurized colostrum within the first hour of life reduces the risk of LOS among VLBW infants admitted to the NICU.
Neonatal Sepsis ; Colostrum ; Infant, Very Low Birth Weight

OBJECTIVES: To study the effect of intrapartum antibiotic prophylaxis (IAP) of group B streptococcus (GBS) infection on the incidence and bacteriological profile of early-onset neonatal sepsis (EONS). METHODS: A retrospective analysis was performed on the medical data of 494 pregnant women with positive GBS screening results and 526 neonates born by these women. According to whether the pregnant woman received IAP, the neonates were divided into two groups: IAP (n=304) and control (n=222). The two groups were compared in terms of clinical indices, incidence rate of EONS, and distribution of pathogenic bacteria in blood culture. RESULTS: Compared with the control group, the IAP group had a significantly lower proportion of children with abnormal clinical manifestations (P<0.001) and a significantly lower incidence rate of EONS (P=0.022). In the IAP group, Escherichia coli (2.3%) was the most common type of pathogenic bacteria in blood culture of the neonates with EONS, while GBS (3.2%) was the most common type of pathogenic bacteria in the control group. The IAP group had a significantly higher detection rate of ampicillin-resistant Escherichia coli than the control group (P=0.029). CONCLUSIONS Although IAP can significantly reduce the incidence rate of EONS in neonates born to pregnant women with positive GBS screening results, the infection rate of ampicillin-resistant Escherichia coli may increase after IAP treatment. Therefore, it is needed to enhance the monitoring of blood culture results of neonates with EONS and timely adjust treatment plan according to drug susceptibility test results.
Anti-Bacterial Agents/therapeutic use* ; Antibiotic Prophylaxis ; Child ; Female ; Humans ; Incidence ; Infant, Newborn ; Infectious Disease Transmission, Vertical/prevention & control* ; Neonatal Sepsis/prevention & control* ; Pregnancy ; Pregnancy Complications, Infectious ; Retrospective Studies ; Streptococcal Infections/prevention & control* ; Streptococcus agalactiae

OBJECTIVES: To study the effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of <35 weeks. METHODS: The medical data were retrospectively collected from 865 preterm infants with a gestational age of <35 weeks who were admitted to the Neonatal Intensive Care Unit of Xiangya Hospital of Central South University from January 1, 2014 to December 31, 2016. The improved antibiotic use strategy was implemented since January 1, 2015. According to the time of implementation, the infants were divided into three groups: pre-adjustment (January 1, 2014 to December 31, 2014; n=303), post-adjustment Ⅰ (January 1, 2015 to December 31, 2015; n=293), and post-adjustment Ⅱ (January 1, 2016 to December 31, 2016; n=269). The medical data of the three groups were compared. RESULTS: There were no significant differences among the three groups in gestational age, proportion of small-for-gestational-age infants, sex, and method of birth (P>0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had a significant reduction in the rate of use of antibiotics and the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days or 4-7 days and a significant reduction in the proportion of infants with a duration of antibiotic use of >7 days in the early postnatal period (P<0.05). Compared with the post-adjustment Ⅰ group, the post-adjustment Ⅱ group had a significant reduction in the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days and a significant reduction in the proportion of infants with a duration of antibiotic use of 4-7 days or >7 days (P<0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had significantly shorter duration of parenteral nutrition and length of hospital stay (P<0.05). There were gradual reductions in the incidence rates of grade ≥Ⅲ intraventricular hemorrhage (IVH) and late-onset sepsis (LOS) after the adjustment of antibiotic use strategy. The multivariate logistic regression analysis showed that the adjustment of antibiotic use strategy had no effect on short-term adverse clinical outcomes, and antibiotic use for >7 days significantly increased the risk of adverse clinical outcomes (P<0.05). CONCLUSIONS It is feasible to reduce unnecessary antibiotic use by the improvement in antibiotic use strategy in preterm infants with a gestational age of <35 weeks, which can also shorten the duration of parenteral nutrition and the length of hospital stay and reduce the incidence rates of grade ≥Ⅲ IVH and LOS.
Anti-Bacterial Agents/therapeutic use* ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; Infant, Premature ; Intensive Care Units, Neonatal ; Retrospective Studies ; Sepsis/epidemiology*