Pulse Oximetry as a Screening Tool To Detect Hypoxia Associated With Early Onset Neonatal Sepsis in Asymptomatic Newborns..

Abstract

Background Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteraemia in the first month of life. The incidence of neonatal sepsis in India is as high as 30 per 1000 live births, and the diagnosis of EOS is often missed due to non specific or absent sign and symptoms. Hypoxaemia, a reduction of the oxygen concentration in arterial blood, is strongly associated with sepsis and is seen in one- third of septic neonates. Pulse oximeter measures oxygen saturation and is a simple, reliable and accurate method for detecting hypoxaemia. Objective i.)To assess the feasibility of using of pulse oximetery as a screening tool to detect Hypoxia associated with early onset neonatal sepsis in asymptomatic newborns and ii.) To exclude cardiac cause of hypoxia. Methodology Hospital based Prospective Observational study was performed. All asymptomatic newborns born after 35 weeks gestational age were screened on two occasions using pulse oximetry. Newborns with oxygen saturation below predefined thresholds( reading below 90%) within 6 hours of life or the repeat readings remained between (90%-94% )within 24 hours of life) were defined as test positive and all these babies underwent a septic screen which included complete blood count, c- reactive protein, blood cultures and chest x ray. Echocardiography was also done in test positive cases to rule out cardiac cause of hypoxia. Test negative newborns were followed up before discharge to ascertain if they were diagnosed to have sepsis. 9 DocuSign Envelope ID: 5DC81E4C98FE4169--D226B94F--44DFF6BC--98B50371-C3D69E141A5033353CC9D12D Results: A total of 282 eligible newborns were screened. Five (5/282, 1.8%) newborns tested positive and all 5 were diagnosed with probable early onset sepsis. All test negative newborns were followed up till discharge and none had evidence of early onset neonatal sepsis at follow up. Conclusion: Early Onset Neonatal Sepsis is one of the major causes of morbidity and mortality among the neonates. Prevalence of EONS in our centre is around 1.8%. Blood Culture is the gold standard for diagnosis of Early Onset Neonatal Sepsis. Our study has demonstrated that pulse oximetry can be used as a screen for early onset neonatal sepsis in asymptomatic neonates. None of the test negative neonates had Early onset sepsis. Our study shows that using pulse oximetry for screening for sepsis is feasible with 100 % sensitivity. It requires minimal training of the hospital staff and on an average about 5 minutes to complete the process of screening. This study may therefore help formulating guidelines on using pulse oximetry to rule out sepsis and firm basis for future research.