Blood Pressure Monitoring for Predicting Mortality in Neonatal Sepsis

Excerpt

When evaluating a neonate presenting with clinical features or risk factors of sepsis, a clinician faces many questions - 1) is the probability of sepsis sufficiently high so as to warrant investigating and starting antibiotic therapy? 2) what is the likely causative organism and to which antibiotics it would be sensitive? 3) how severe is sepsis and will it progress to cause organ dysfunction (e.g., shock) and death? If the probability of sepsis is sufficiently high to cross the test-treatment threshold (an arbitrary and usually subconscious value but present nevertheless) set by the clinician, the neonate will undergo laboratory investigations and be administered empirical antibiotic therapy. While awaiting the results of the laboratory workup, the clinician and family grapple with the question of the risk of progression and death. One of the most important predictors of the adverse outcome in neonatal sepsis is blood culture-positive sepsis. Neonates with culture-positive sepsis are at about 30 times greater relative risk of death than neonates without sepsis [1]. However, only a small proportion of neonates who are evaluated for sepsis or even die with the diagnostic label of sepsis have culture-positive sepsis. In addition, culture positivity is not known till 12–72 h after incubating the blood sample. Until then, the clinician has to rely on the clinical status of the neonate. …