Predictors of Neonatal Sepsis in Rural Karnataka, India

Background: Neonatal sepsis can present with subtle signs but have a fulminant and fatal course if not recognised and treated early. Many practitioners in resource-poor settings are forced to empirically manage infants at risk for sepsis without access to blood cultures. We sought to identify predictors of poor outcomes in infants with suspected sepsis at a hospital in rural Karnataka, India.

Materials and Methods: This was an observational study of infants aged zero to 30 days who were admitted from January to December 2011 with a diagnosis of presumed bacterial sepsis. We extracted perinatal risk factors, gestational age, birth weight, history and physical exam at the time of admission, white blood cell count, C-reactive protein, duration of hospitalisation, disposition, and blood culture results from medical charts. Poor outcome was defined as death, positive blood culture, hospitalisation greater than five days, or transfer for higher level of care. We calculated predictive values and odds ratio for each variable using univariate logistic regression.

Results: Seventy-nine infants were included; 58 (73.4%) experienced a poor outcome. Prematurity and temperature instability were significantly associated with poor outcome, with trends towards higher risk for those having very low birth weight, convulsions, a bulging fontanelle, or lethargy on admission. Nine blood cultures were positive, including seven with Staphylococcus.

Conclusions: In a cohort of infants admitted for presumed sepsis in rural Karnataka, prematurity and temperature instability were associated with poor outcome. Larger studies are needed to evaluate bacterial aetiologies and determine the optimal antibiotic regimen.