2017, Number 4
Rev Med MD 2017; 8.9 (4)
López-Altamirano D, Angulo-Castellanos E, Castellanos-González CH, Torres-Baranda JR, García-Morales E
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ABSTRACTIntroduction. Early neonatal sepsis is defined as a systemic response to a documented infection in newborns from birth and up to the first 72 hours of life. In Mexico the reported incidence is of 15-30/ 1000 newborns, with 25-30% lethality. Polymerase chain reaction with restriction fragment length polymorphism has 100% sensitivity and 95.6% specificity for the diagnosis of sepsis and using only one drop of blood. On the other hand, blood cultures have a sensitivity of 30-40% for 1ml of blood. The routine use of this test could lower hospitalization costs, detect coexisting viral infection and reduce the amount of sample needed. This is enough to compare the efficacy of RCP-RFLP with blood cultures for the diagnosis of early neonatal sepsis. Due to this, the present study was meant to evaluate the efficacy of PCR-RFLP compared to blood culture to diagnose early neonatal sepsis in newborns.
Material and Methods. This is a prospective study for a diagnostic test at the Hospital Civil de Guadalajara Fray Antonio Alcalde from January to December 2015. A sample of 30 newborns was calculated to have a statistical power of 80%. Patients of both genders with 0-72 hrs of life with risk factors for sepsis were included; we excluded patients with previous history of antibiotic use and / or transfusion of blood products. We performed an analysis using the SPSS Statistics software.
Results. Of the population studied, half were female. 15 patients were preterm, 14 were term newborns and 1 post-term. The mean age was 36 weeks of gestational age (28-42.1). There were 3 positive blood cultures, of these, 1 patient presented concomitant elevation of acute phase reactants and the other 2 only presented compatible clinical scenario. With this, blood culture had a sensitivity of 100%, specificity of 93% and a negative predictive value of 100%; compared to only 1 positive case with the PCR technique having a sensitivity of 33%, specificity of 100% and NPV of 93%.
Discussion. In this study we found three sepsis cases using blood culture with a predominance of female patients, and six more using clinical manifestations. The low sensibility of PCR in this study could be associated to the use of antibiotics in 20 mothers before birth and the size of the sample. PCR-RFLP is no more effective than blood cultures as a diagnostic test for early neonatal sepsis. On the other hand it is helpful as a sieving tool .