Risk of sepsis in newborns with severe hyperbilirubinemia

2. Risk of sepsis in newborns with severe hyperbilirubinemia Dr. Saad Alsaedi, MD, FAAP, FRCPCAssociate professor of pediatrics, Neonatologist, KAUH, Jeddah

3. 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

4. most neonates are discharged home < 48h readmission of a newborn to the hospital forsevere jaundice in the 1st. Wk of life becomecommon

5. Should these newborns be subjected to septic work up (CSF, blood and urine cultures even if they appear otherwise well?

6. 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

7. This retrospective study was conducted in King Abdulaziz University Hospital Jeddah, Saudi Arabia • 5000 delivery/year

8. Inclusion Criteria • Term newborns admitted to pediatric ward with severe jaundice • Healthy • Age 1 to 30 days

9. 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

10. Age Feeding Diagnosis Data collection Wight Antibiotics Duration of hospitalization

11. CBC Bilirubin Retic. count Laboratory Data Blood film G6PD screen Blood, CSF, urine cultures

12. Results Table1. characteristics of 197 Neonates with unconjugated Jaundice* *feeding information is not available in 55 (27.9% Newborn

13. Type of feeding in the study population

14. Age at the time of admissionof the study population Percent

15. Table 2. Clinical Data

16. 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%

17. Laboratory Investigations • Blood culture from 14 (7.5%) newborns grew coagulase negative staphylococcal species which was considered contaminants by the treating physician

18. Table4. Discharge diagnosis

19. G6PD done in only 82 infants(41.6%) • Deficient in 12 infants (14.6%) • Reticulocytes increased in infants 3 (25%)

20. Discussion • Blood culture, CSF examination and urine culture were performed in 93%, 72.5%, and 89% respectively of the study population

21. Discussion • performing full septic work up in these newborns is a common practice in our hospital

22. Discussion • None of these newborn had sepsis or meningitis • Urinary tract infection was documented in 9 patients (4.5%).

23. 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

24. 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

25. 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

26. 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

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

28. Discussion Maisels et al, 1992 Obtained urine cultures in 126 newborns (4 1 .2%) but none were positive

29. Discussion Garcia et al 2002 Reported UTI in 7.5% of 160 asymptomatic jaundiced infants < 8 wks old who presented to their emergency department

30. Conclusion • Healthy term newborns who require readmission to hospital for indirect jaundice do not need to be investigated for sepsis

31. Conclusion • If indirect jaundice is ever the only manifestation of bacteremia or incipient sepsis, it must be a rare event

32. 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

33. Conclusion • G6PD screening should be done in all male newborns with severe jaundice requiring phototherapy

34. Thank You

35. Table4. Discharge diagnosis

36. Table2. Clinical Data

37. The following data were collected: • Weight • Age • Feeding • Antibiotics • Duration of hospitalization • Diagnosis

38. The following Lab. Data were collected: CBC Total and direct bilirubin Blood film Reticulocyte count G6PD screen Blood, CSF, and urine culture