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Septic Shock in Neonate: Clinical Profile and its Outcome

Author(s): M. A. Mannan, Mosammad Alpana Jahan, Md. Arif Hossain, Afroza Islam Shuma, Sadeka Choudhury Moni, Ismat Jahan, Mohammad Kamrul Hassan Shabuj, Mohammod Shahidullah

Background: Sepsis is one of the leading causes of neonatal mortality worldwide. Shock is usually accompanied with sepsis. Documentation of presentations and causative organisms is crucial to manage the newborn with septic shock.

Objective: The objective of this study was to describe the clinical profile and outcome of newborns with septic shock.

Materials and methods: This retrospective study was conducted in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2019 to December 2020. A total of144 neonates with septic shock were included in this study. Hospitalized inborn and out born babies were enrolled. Baseline data of selected neonates were retrieved from the registry book. Time of onset of sepsis, presentation of shock with their management and hospital outcome were collected. Data were analyzed in SPSS version 20. Statistical analysis was performed to establish the relationship between neonatal variables and outcomes with septic shock.

Results: Among 1086 admitted newborns, 536 (49.4%) developed sepsis, of which 144 (26.86%) newborns developed septic shock. The mean gestational age and birth weight were 34.32±2.88 wk and 1886.50±744.9g respectively. One hundred and eight newborns were premature and 90.3% developed sepsis at >72 hours of age. Newborns with septic shock were presented with tachycardia (100%), prolonged CRT (98.6%), cold peripheries (75%), low pulse volume (44.4%), and 38.9% newborns had low blood pressure. Culture-positive sepsis was 31.2% cases. One hundred newborns recovered from septic shock within 72 hours (69.4%) and 64.6% of newborns survived after septic shock. The predictors of outcome of mortality were male sex, age of onset of sepsis >72 hours, positive blood culture, mechanical ventilation and DIC. No variables were found significant in binary regression analysis.

Conclusion: In this study, 26.86% (144/536) septic neonates developed septic shock in the course of NICU stay. The common presentation of shock in newborns were tachycardia, prolonged CRT, cold peripheries, low pulse volume and mottled skin; the incidence of hypotension was 38.9%. Neonatal death after the onset of septic shock was 35.4%. Early recognition and prompt management can improve the survival of neonates.

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