Background: : Neonatal sepsis is the most common cause of neonatal mortality in Lao PDR, however, there are limited contemporary data on the incidence of early-onset sepsis in Lao PDR. Antibiotics are most commonly used in intensive care units and intermediate care unit for maternal risk and clinical signs of early-onset neonatal sepsis. Objectives: : To describe early-onset neonatal sepsis by clinical signs, laboratory results, and antibiotic usage in neonates admitted to Mother and Newborn Hospital and Mahosot Hospital in Vientiane, Lao PDR Methodology: : This study is a descriptive study of neonates admitted within 3 days of life, early-onset neonatal sepsis was defined as a neonate who presented with two or more clinical signs or laboratory results suggesting sepsis and received antibiotics for at least 3 days. Results: : Among 500 cases the common clinical presentations of EOS are oxygen requirement or need for ventilation support in 304 infants (60.8%) temperature instability in 223 infants (44.6%) and increased serum bilirubin in 154 infants (30.8%) There were 13 infants (2.6%) diagnosed with culture-proven sepsis from positive blood culture. The causative organisms were predominantly gram-negative bacilli such as Escherichia coli, and Acinetobacter baumannii, and gram-positive cocci such as Staphylococcus aureus, and Group B Streptococci. The rate of antibiotic usage is very high, ampicillin was prescribed in 489 (97.8%) and gentamicin in 438 infants (87.5%), the duration of antibiotic therapy was 5 to 14 days. Conclusion: The rate of culture-proven early-onset neonatal sepsis was low, but there was a very high rate of antibiotic usage. Antibiotic stewardship should be strongly emphasized.

Objective: we aimed to investigate the possible causes of death among preterm and LBW infants admitted to the post-delivery ward and/or NICU at Mahosot Hospital, Lao PDR, and the possible factors that influence preterm and LBW infants’ survival. Methods: A retrospective cross-sectional study was conducted between by reviewing the treatment and outcomes for preterm and LBW infants admitted July - November 2017 to Mahosot Hospital in Vientiane, Lao PDR. Results: Of 3,500 births in 2017, 224 (6.4%) were preterm, 350 (9.4%) were LBW and 106 (30.2%) were term LBW; 98 preterm births (43.8%) and 21 (19.8%) term LBW babies were admitted to the NICU. Enrolment included 93 cases including 86 (92.5%) preterms and 7 term LBW neonates, of whom 47 (54.7%) and 2 were admitted to NICU, respectively. Enrollees were mostly male, Lao Loum, born vaginally at Mahosot Hospital; 3.2% were extreme preterm, 15.1% were very preterm, 74.2% moderate to late preterm and 7.5% term LBW; 2.2% were extremely LBW, 16.1% very LBW, 63.4% LBW and 18.3% normal birth weight. All 44 (47.3%) preterm or LBW babies admitted to the postnatal ward survived. Of the 49 (52.7%) admitted to the ICU, 18.4% died. All neonates who died were preterm of gestational age ranging 25-36 weeks and birth weight 730-2220g. Babies admitted to the NICU were mostly diagnosed with respiratory distress syndrome (RDS, 39.7%), neonatal infections (31.7%), asphyxia (9.5%) and congenital malformations (4.8%). Patient care. Antenatal: 5.9% of preterm births <32 weeks received magnesium sulfate, and 27% of births 24-34 weeks gestational age received antenatal steroids. Postnatal: 37.6% received skin-to-skin contact (SSC), and 15% maintained SCC until breastfeed completed, 68.8% received exclusive breastmilk as first feed and 24.5% kangaroo mother care. Only 7.5% were monitored for hypoxemia and 24.7% for hypothermia. Weights were not checked prior to discharge. Case management: Around two-thirds of babies with risk factors for sepsis received prophylactic antibiotics. Most (77.6%) babies during the NICU admission received antibiotics, all of whom had a CBC and blood culture; but half without a diagnosis of sepsis or risk factors. Most (79.6%) preterm and LBW babies admitted to the NICU were given oxygen. About one-quarter of babies with RDS died. Very LBW infants rarely received supplementation with vitamin D, phosphate, iron and calcium. Conclusions Most study participants were late preterm and LBW. Just under 10% died. Care can be improved, including antenatal administration of magnesium sulfate and antenatal steroids that needs to be vastly increased for eligible mother in preterm labor. Respiratory management needs further investigation for gaps. Feeding with breastmilk and checking vital signs appear to be strengths.