[5450A.3] Causes and Timing of Sepsis and Neonatal Mortality in the Indian Community Setting
P. Panigrahi, S.S. Mohapatra, R.N. Satpathy, L. Pradhan, P.R. Misra, R. Chaudhry, J.G. Morris, J.A. Johnson, I.H. Gewolb, N. Hansen, L. Wright, S.N. Parida. Pediatrics, U of Maryland, Baltimore; Kalinga Hosp; IGH; Capital Hosp, Orissa; AIIMS, Delhi; Mich State Univ, MI; RTI Intl, NC; NICHD, Bethesda; SCB Medical Coll, India.
BACKGROUND: Sepsis is a major cause of neonatal death in developing countries. India accounts for 33% of global neonatal deaths, most in rural villages. Limited data are available on death rates, timing and cause of death, including sepsis.
OBJECTIVE: To determine the neonatal mortality rate (NMR), mortality rate to 60 days, sepsis rates, and timing of sepsis in two districts in rural Eastern India.
DESIGN/METHODS: A prospective population-based study was conducted in 223 villages between April 2002-March 2005.Village Anganwadi workers (AWW) evaluated every infant; they were trained to identify cases of suspect sepsis via daily home visits until babies were 60 days old and to refer them to two study hospitals where they were examined by physicians. About one-third of referred infants were admitted for complete septic-workups and treatment. Blood/CSF (Bactec) cultures were done including species identification by API methods. Full time field workers monitored all aspects of the study. All deaths were confirmed through hospital records or through verbal autopsies administered to families by trained field staff. Cause of death was assigned by two independent pediatricians.
|0-3 d||4-7 d||8-28 d||29-60 d|
|Total births recorded by AWW||12,622|
|Admitted for clinical sepsis||842||38||103||375||326|
|Deaths in study hospitals||35||7||4||14||10|
|Total deaths in study area||423||165||82||126||50|
|Total sepsis-related deaths||182||16||36||88||42|
|% deaths related to sepsis||10% (16/165)||44% (36/82)||70% (88/126)||84% (42/50)|
There were 29.6 deaths/1000 live births (NMR) during 0-28 d and 33.5 deaths/1000 live births during 0-60 d. Of the 842 infants admitted, 17.6% had a positive blood culture. Coagulase negative Staphylococci, Klebsiella, E. coli, and S. aureus were predominant organisms.
CONCLUSIONS: Sepsis was responsible for >40% of all deaths after day 4 (but only 10% during day 0-3). Programs targeting reduction in infection-related infant mortality in the Indian community setting should focus on the period between 4-60 days with emphasis on newborn care during the early neonatal period. Funded by the NICHD Global Network and the Bill and Melinda Gates Foundation.
Tuesday, May 2, 2006 10:45 AM
Platform Session: Neonatal Infectious Diseases in Developing Countries (10:15 AM - 12:15 PM)
Course Number: 5450A