Khalid N Haque, Talal Waqar, Sohail Salat, Durreshashwar Khan, Saba Mushtaq, Asad Maqbool.
Neonatal Infections in Pakistan: Piloting the Neonatal Sepsis Surveillance Group (nSSG): a Plea for Developing Neonatal Networks to Improve Quality of Neonatal/ Perinatal Care in Pakistan. on Behalf of Neonatal Sepsis Surveillance Group.
Pak Paed J Jan ;43(4):228-38.

Objective: Neonatal sepsis is a major cause of mortality throughout the world and in Pakistan. To determine the epidemiology of neonatal sepsis and test the feasibility of establishing a collaborative network in Pakistan a Neonatal Sepsis Surveillance Group (nSSG) was set up. Study Design: Ongoing prospective multicentre monthly and cumulative analysis. Place and Duration of Study. Network of neonatal units in four provinces of Pakistan. November 1st 2018 and April 30th 2019. Material and Methods: Participating units reported their monthly sepsis data on a standardised proforma. The study coordinator collated and analysed the results and fed back to the participants. Results. During the study period 1303 neonates were admitted. 1105 (84.8%), were screened or suspected and treated for sepsis {range 50.9% - 119.6%), {frequency 805/1000 admissions}. 137 (12.3%) {range 5.8% - 29.2%} had culture positive (proven) sepsis. 430 (38.9%) {range 27.2% - 74.2%} had culture negative sepsis. Overall mortality was 9.1% (101/1105) {range 2.7% - 30.5%} which equates to 7.70% (101/1303) or 77.5/1000 admissions. Mortality from proven early onset of sepsis (EOS) was 17.5% (24/137) {range 2.7% to 37.5%} and 4.80% (21/430) {range 2.9% - 6.5%} in culture negative cases. Mortality from proven late onset sepsis (LOS) was 10.9% (15/137) {range 2.0% - 37.5%} and 9.50% (41/430) {range 2.7% - 40.9%} in culture negative sepsis. Overall mortality in culture positive sepsis was 28.4% (39/137) and 14.4% (62/430) in culture negative sepsis. Three common organisms were; Klebsiella pneumoniae, Acinetobacter and Enterococcus, frequently antibiotics used were Amikacin, Meropenem and Tazobactum with Pipperacillin. Conclusion. Our data shows wide variations in epidemiology and outcome. Establishment of nSSG is feasible. It improved quality of neonatal care.

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