Early diagnosis essential to treat Septicaemia in neonates: expert

Dr Raghuram Mallaiah, Senior Director and Neonatologist at Fortis La Femme Hospital, Delhi, discusses the rise of septicaemia as the top cause of neonatal deaths in Delhi, as highlighted in the “Annual Report on Registration of Births and Deaths in Delhi-2023.”

On average, how many neonates with septicaemia do you treat annually? 

We treat about 3-4 term neonates with septicaemia annually out of 1,400-1,500 births. Preterm babies, with their underdeveloped immune systems, have a much higher incidence of 20-40% in our NICU.

What are the primary criteria you use to diagnose septicaemia in neonates? 

For term babies, symptoms include fever, poor feeding, lethargy, or irritability. In preterm babies, diagnosis is harder and may involve respiratory issues or apnea. Diagnosis relies on blood tests like blood culture, CBC, CRP, and urine tests.

How often do you update or review these protocols?

Our protocols, such as blood cultures and CBC, are longstanding gold standards. New markers like CRP have been added in recent years, but fundamental protocols are updated only with new, validated markers.

What is the average time from diagnosis to initiation of treatment in your facility? 

Treatment starts immediately upon suspicion of septicaemia. Blood tests are done, and antibiotics are given before results, which can take 48-72 hours for cultures and 2-4 hours for CBC and CRP.

 Are there any delays recently in this process?

No, we strictly follow protocols, starting treatment promptly due to babies’ inability to communicate symptoms.

What type of supportive care is typically provided to neonates with septicaemia? 

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Supportive care includes ventilator support, CPAP, oxygen, IV fluids, and nasogastric tube feeding. Early intervention improves effectiveness.

What are the key factors contributing to the high mortality rate among neonates with septicaemia in your facility?

High mortality, especially in preterm babies, is due to low birth weight and weak immune systems. Babies born under 1 kg are particularly vulnerable.

How do the outcomes for septicaemia compare with other neonatal conditions you treat?

In urban settings, septicaemia is the leading cause of mortality in preterm babies. In rural or government hospitals, birth asphyxia is more common. Jaundice, if treated, is less likely to be fatal.

What infection control practices are in place to prevent septicaemia? 

Prevention includes strict hand-washing, minimising invasive procedures, early feeding, and limiting NICU visitor access. Breastfeeding provides protective antibodies.

What are the most significant challenges you face in managing neonatal septicaemia? 

Challenges include early diagnosis, rapid treatment initiation, and providing supportive care, especially for preterm babies.

 Are there any specific barriers related to resources, staffing, or training that impact care delivery? 

Timely hospital arrival is crucial. Urban areas usually manage this well, but rural or lower socioeconomic regions may face delays. Early diagnosis and treatment are vital once the baby arrives.

What recommendations do you have for reducing the mortality rate associated with septicaemia?

Early diagnosis and treatment are essential. Faster diagnostic methods, like PCR tests, and immunoglobulins could improve outcomes.

Are there any innovative practices you believe could make a difference? 

Faster diagnostic tests like PCR and targeted antibiotic therapy based on quicker pathogen identification may enhance treatment. Immunoglobulins might also be beneficial.

Do you have any additional comments or insights regarding the management of sepsis that you would like to share? 

Early intervention and strict protocol adherence are crucial. Preventive measures such as strict hand hygiene and promoting breastfeeding are especially important for preterm babies.