Publication:

The utility of umbilical cord blood culture in the diagnosis of early onset sepsis in neonates at a tertiary care hospital

Background Umbilical cord offers an alternative site for blood culture collection. Umbilical cord blood culture (UCBC), obtained aseptically immediately after delivery, is painless, technically simpler method that allows collection of an adequate blood volume before antibiotic exposure. Objective was to study utility of UCBC in the diagnosis of early onset sepsis in neonates

Methods Hospital based prospective study was carried out among 100 neonates delivered by normal vaginal delivery (NVD) and lower segment caesarean section (LSCS), who were at risk of developing EOS. Information was collected from structured proforma for each patient. Details of newborn and mother/Risk factors including maternal and neonatal risk factor was taken/clinical feature of newborn risk for early onset sepsis was taken. Qualifying patient underwent detailed history, clinical examination and sepsis screening was sent in NICU. Umbilical cord blood sample was processed for five days and growth and antibiotic sensitivity was reported.

Results Majority mothers were <20 years (47%). Mostly they belonged to gestational age of 28-34 week. Majority had birth weight between 1-1.5 kg (37%). Most common risk factor was pre-mature rupture of membranes (72%). Tachypnea was most common clinical feature (35%). 33% were culture positive by UCBC compared to 17% by peripheral venous blood culture (PVBC). Most common organism isolated by UCBC was Acinetobacter (11%). Sensitivity, specificity, PPV, NPV sepsis screening compared to UCBC was 90.9%, 53.7%, 49.2%, 92.3% respectively. Sensitivity, specificity, PPV, NPV of sepsis screening compared to PVBC was 82.4%, 43.4%, 22.9%, 92.3% respectively. Sensitivity, specificity, PPV, NPV of UCBC compared to PVBC was 77.8%, 76.8%, 42.4%, 94.03% respectively.

Conclusions Early-onset neonatal sepsis was more common among preterm, low-birth-weight neonates and those exposed to maternal risk factors, particularly PROM.