title: Neonatal sepsis as a major cause of morbidity in a tertiary center in Kathmandu.
abstract: BACKGROUND
  Neonatal sepsis causes high morbidity and mortality of newborns. The study aims to study the predictors and clinical, haematological and bacteriological factors of neonatal sepsis.
  
  
  METHODS
  A descriptive cross sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of Paropakar Maternity and Women's Hospital in Kathmandu between October and December 2011. Demographic, obstetrics, clinical and microbiological data were studied for 300 neonates.
  
  
  RESULTS
  The NICU prevalence rate of sepsis was 37.12%. Early onset neonatal sepsis was common (91.39%) (P=0.000). Cesarean section (OR 1.95, 95% CI 1.15-3.31), apgar score<4 at 1 min (P=0.00) and <7 at 5 min of birth (P=0.00) predicted sepsis. Neonates with sepsis were more likely to present with hypothermia (OR 1.180, 95% CI 0.080-17.214), pustules (OR 2.188, 95% CI 0.110-43.465), dehydration (OR 3.040, 95% CI 0.170-54.361), diminished movement (OR 3.082, 95% CI 0.433-21.950) and bulging fontanels (OR 16.464, 95% CI 0.007-41495.430). Coagulase negative Staphylococcus spp. (CoNS) (21, 41.17%) was most common pathogen of neonatal sepsis. Variable antibiotic resistance patterns of isolates with emergence of meropenem resistance in Pseudomonas spp. and methicillin resistance in CoNS and S. aurues were noted. Mortality due to sepsis was highest (15, 8.06%) among total mortalities (21, 11.29%).
  
  
  CONCLUSIONS
  Delivery via cesarian section, apgar score<4 at 1 min, and <7 at 5 min predicted sepsis. Morbidity and mortality of neonatal sepsis was common in this setting and early maternal and neonatal interventions are required to address this issue.
authors.affiliation: Genesis Laboratory and Research, Kathmandu, Nepal.
authors.forename: Badri
authors.initials: B
authors.lastname: Thapa
authors.affiliation: Genesis Laboratory and Research, Kathmandu, Nepal.
authors.forename: Anurag
authors.initials: A
authors.lastname: Thapa
authors.affiliation: Paropakar Maternity and Women's Hospital, Kathmandu, Nepal.
authors.forename: Dhan Raj
authors.initials: DR
authors.lastname: Aryal
authors.affiliation: Paropakar Maternity and Women's Hospital, Kathmandu, Nepal.
authors.forename: Kusum
authors.initials: K
authors.lastname: Thapa
authors.affiliation: UNICEF, Country Office for Nepal, Kathmandu, Nepal.
authors.forename: Asha
authors.initials: A
authors.lastname: Pun
authors.affiliation: UNICEF, Country Office for Nepal, Kathmandu, Nepal.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Khanal
authors.affiliation: SOPHYN, Kathmandu, Nepal.
authors.forename: Kishori
authors.initials: K
authors.lastname: Mahat
mesh_terms: D001034:Apgar Score; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality; D008297:Male; D008826:Microbial Sensitivity Tests; D009390:Nepal; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D062606:Tertiary Care Centers