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Risk of sepsis in newborns with severe hyperbilirubinemia. Dr. Saad Alsaedi, MD, FAAP, FRCPC Associate professor of pediatrics, Neonatologist, KAUH, Jeddah. Bacterial infection is a recognized cause of neonatal jaundice

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risk of sepsis in newborns with severe hyperbilirubinemia

Risk of sepsis in newborns with severe hyperbilirubinemia

Dr. Saad Alsaedi, MD, FAAP, FRCPCAssociate professor of pediatrics, Neonatologist, KAUH, Jeddah

slide3
Bacterial infection is a recognized cause of neonatal jaundice

some reports suggest that unexplainedindirect jaundice may be theonly manifestation of sepsis in healthy newborns

Rooney JC, et al 1971 Linder N et al 1988 Chavalitdhamrong P-O, et al 1975

slide4
most neonates are discharged home < 48h

readmission of a newborn to the hospital forsevere jaundice in the 1st. Wk of life becomecommon

slide5

Should these newborns be subjected to septic work up (CSF, blood and urine cultures even

if they appear otherwise well?

objective
Objective

To test the hypothesis that bacterial sepsis

is not a cause of severe indirect jaundice in

otherwise healthy newborns admitted to the

hospital for phototherapy

slide7

This retrospective study was conducted

in King Abdulaziz University Hospital

Jeddah, Saudi Arabia

  • 5000 delivery/year
inclusion criteria
Inclusion Criteria
  • Term newborns admitted to pediatric ward with severe jaundice
  • Healthy
  • Age 1 to 30 days
methods
Methods
  • The medical records of all neonate admitted to pediatric ward with a diagnosis of neonatal jaundice were reviewed (Apr 2000- Apr2008)
  • All newborns who met the inclusion criteria

were selected

slide10

Age

Feeding

Diagnosis

Data collection

Wight

Antibiotics

Duration of hospitalization

slide11

CBC

Bilirubin

Retic. count

Laboratory Data

Blood film

G6PD screen

Blood, CSF, urine cultures

results
Results

Table1. characteristics of 197 Neonates with

unconjugated Jaundice*

*feeding information is not available in 55 (27.9% Newborn

table3 laboratory investigations
Table3. Laboratory Investigations

Blood culture from 14(7.5%) newborns grew coagulase negativestaphylococcal species which was considered contaminants by

the treating physician. G6PD +ve in12, 14.5%

laboratory investigations
Laboratory Investigations
  • Blood culture from 14 (7.5%) newborns grew coagulase negative staphylococcal species which was considered contaminants by the treating physician
slide19
G6PD done in only 82 infants(41.6%)
  • Deficient in 12 infants (14.6%)
  • Reticulocytes increased in infants 3 (25%)
discussion
Discussion
  • Blood culture, CSF examination and urine culture were performed in 93%, 72.5%, and 89% respectively of the study population
discussion21
Discussion
  • performing full septic work up in these newborns is a common practice in our hospital
discussion22
Discussion
  • None of these newborn had sepsis or meningitis
  • Urinary tract infection was documented in 9 patients (4.5%).
discussion23
Discussion

Maisels et al, 1992

  • reported no case of sepsis in 306 newborns with severe hyperbilirubinemia.
  • only 19% of neonates in their study had a blood culture performed
discussion24
Rooney et al 1971

Described a series of 22 newborns with

documented bacterial infection and jaundice

they did not exclude jaundiced newborns with other signs of sepsis

Several newborns had significant elevations of direct reacting bilirubin

Discussion
discussion25
Linder et al 1988

identified 93 jaundiced, term infants, < 7 days

Three had positive blood culture

(k. pneumonia, proteus mirabilis & Bacteroides sp)

All three had other signs of sepsis

Discussion
discussion26
Discussion
  • Chavalitdhamrong et al 1975
  • a prospective study of 69 newborns

with unexplained jaundice

  • bacterial infection in only 2
  • Both had asymptomatic Gram

negative UTI

discussion27
Discussion
  • We obtained urine cultures in 176 newborns (89%)
  • UTI was documented in 9 patients (4.5%)
discussion28
Discussion

Maisels et al, 1992

Obtained urine cultures in 126 newborns

(4 1 .2%) but none were positive

discussion29
Discussion

Garcia et al 2002

Reported UTI in 7.5% of 160 asymptomatic

jaundiced infants < 8 wks old who presented

to their emergency department

conclusion
Conclusion
  • Healthy term newborns who require

readmission to hospital for indirect jaundice

do not need to be investigated for sepsis

conclusion31
Conclusion
  • If indirect jaundice is ever the only manifestation of bacteremia or incipient sepsis, it must be a rare event
conclusion32
Conclusion
  • UTI in a symptomatic, jaundiced newborns is a rare events
  • It is still unknown whether jaundice in these population is a result of or a coincident with UTI in the absence of a control group
conclusion33
Conclusion
  • G6PD screening should be done in all male newborns with severe jaundice requiring phototherapy
slide37

The following data were collected:

  • Weight
  • Age
  • Feeding
  • Antibiotics
  • Duration of hospitalization
  • Diagnosis
the following lab data were collected
The following Lab. Data were collected:

CBC

Total and direct bilirubin

Blood film

Reticulocyte count

G6PD screen

Blood, CSF, and urine culture