Neonatal sepsis is a systemic infection occurring in infants within 28 days of life and is a major cause of morbidity and mortality in newborns [1]. According to the international pediatric consensus conference of 2001, neonatal sepsis was defined as systemic inflammatory response syndrome in the presence of or as a result of suspected or proven infection with or without accompanying bacteremia, documented by a positive blood culture in the first 28 days of life [2].
Sepsis encompasses various systemic infections of the new born such as: septicemia, meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections [3]. Neonatal sepsis is caused by both gram-positive and gram negative bacteria’s [4, 5].
Neonatal sepsis is classified into two major categories based on the time of onset: early-onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS). Early-onset neonatal sepsis appears within the first seven days of life and most cases appear within 24 h of birth. While late onset neonatal sepsis occurs after 8 days of infants life and is mostly acquired after delivery [5, 6].
Sepsis is diagnosed by: a complete white blood cell count with differential, blood culture, urine cultures, and a lumbar puncture for cell count and culture. To clear the diagnosis of early onset sepsis factors that predispose the neonate for sepsis such as maternal infection and prolonged rupture of membranes, and prematurity are also considered [1, 6].
Signs and symptoms of infection in neonates are subtle and non-specific, may present with one or more of the following: hypothermia or fever, lethargy, poor cry, refusal to suck, poor perfusion, prolonged capillary refill time, hypotonia, absent neonatal reflexes, bulging fontanel, brady/tachycardia, respiratory distress, apnea and gasping respiration, hypo/hyperglycemia, and metabolic acidosis [3, 6, 7].
Risk factors for early onset of sepsis includes premature rupture of membrane (PROM), fever, chorioamnionitis, repeated vaginal examination, meconium stained amniotic fluid, dietary intake of contaminated foods, cervical cerclage, place of birth, prematurity, low birth weight, complicated or instrument-assisted delivery, and low appearance pulse grimace activity respiration (APGAR) scores. Late onset of sepsis acquiring nosocomial infections and invasive procedures during hospital admission [1, 6, 8].
Antimicrobials used to treat sepsis are combinations and in most units are penicillin (Benzyl penicillin, Ampicillin, or Cloxacillin) together with an aminoglycoside, most commonly Gentamicin and is largely preventable by timely recognition, rational antimicrobial therapy and aggressive supportive care [3, 9].
Globally, sepsis is one of the major causes of morbidity and mortality among neonates [4], according to WHO sepsis caused approximately 12% of the 2.9 million neonatal deaths in 2012 [10]. Out these deaths 99% occur in developing countries [11].
In Africa sepsis accounts 28% neonatal deaths [12] and infectious causes accounts 68 deaths per 1000 live births [13]. In Ethiopia from prenatal mortalities sepsis covers 5% [14]. In Debrezeyt, Ethiopia the overall poor outcomes of NS were 26% including deaths [8].
Therefore the purpose of this study was to assess clinical outcomes and risk factors of neonatal sepsis in Felege Hiwot referral hospital, Bahir Dar, North West Ethiopia.