Allah Rakhia, Mashal Khan, Syed Furqan Hasan, Muhammad Ayaz Mustufa, Ashfaque Ahmed Memon.
Diagnosis of neonatal septicemia; thinking beyond blood culture.
Pak J Med Res Jan ;56(4):121-5.

Background: Neonatal sepsis (NS) is a major cause of neonatal admissions to hospital and mortality. This study was conducted to evaluate different methods for rapid and reliable diagnosis of NS with an aim to rationalize the use of antibiotics and stay in Neonatal Intensive Care Unit. Objectives: To compare the different available methods for rapid and reliable diagnosis of neonatal sepsis. Study design, settings and duration: This comparative study was conducted in Emergency Department of National Institute of Child Health (NICH) Karachi for the period of six months. Subjects and Methods: Neonates who were brought to the emergency department of National Institute of Child Health with suspicion of NS were clinically examined. Those, supposed to be septic were included as study population and informed written consent was taken from their parents. After this, 3 ml blood was drawn for complete blood count (CBC), blood culture, C-reactive protein (CRP), polymerase chain reaction (PCR) and neutrophilic ratio. PCR and CRP results were compared with blood culture for specificity, sensitivity, positive and negative predictive values. Results: Out of 129 neonates, 23 (17.82%) were positive for bacterial DNA by PCR method while 42 (32.55%) were positive for infection when tested for C reactive protein marker of the blood. Whereas, only 15 (11.62%) were positive by blood culture. Sensitivity and specificity of PCR were 60% and 88% while positive and negative predictive values were 39% and 94% respectively. Sensitivity and specificity of C reactive protein were 60% and 71% while positive and negative predictive values were 21% and 93% respectively. Conclusion: Our study revealed high specificity and positive predictive values of PCR suggesting that PCR is more reliable, rapid and specific adjunct of blood culture for diagnosis of NS. Key words: Neonatal sepsis, blood culture, PCR, CRP.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com