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A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam

Journal of Perinatology volume 35, pages 846–851 (2015)Cite this article

Subjects

Abstract

Objective:

The objective of this study is to determine the prevalence, causes and outcome of sepsis in hospitalized neonates in the largest neonatal unit in central Vietnam.

Study Design:

A 1-year prospective cohort study of newborns admitted to the neonatal unit in Da Nang. A sepsis work-up including blood culture was undertaken before commencing antibiotics for neonates with suspected sepsis.

Result:

Of 2555 neonatal admissions, 616 neonates had 729 episodes of suspected invasive sepsis. A pathogen was isolated from blood in 115 (16%) episodes in 106 neonates. The prevalence of early-onset sepsis (EOS) was 8 (95% confidence interval (CI): 4 to 11) per 1000 admissions, and of late-onset sepsis (LOS) was 34 (95% CI: 27 to 41) per 1000 admissions. Of 86 neonates with LOS, 69 (80%) also fulfilled the criteria for nosocomial sepsis. The commonest bacterial causes of EOS were coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus, and of LOS were Acinetobacter, CoNS and Klebsiella pneumoniae. Fungal sepsis occurred in 35 neonates of which most were nosocomial sepsis. In vitro resistance to multiple antibiotics was common among Gram-negative bacteria. Antibiotics were prescribed and given to 68% of all admissions, and 14% of all admissions received four or more different antibiotics. The case fatality rate for confirmed sepsis was 46%.

Conclusion:

Late-onset, nosocomial sepsis was common and associated with a high mortality in hospitalized newborns in the largest neonatal unit in central Vietnam. These findings highlighted the need for improved infection control measures and antibiotic stewardship, which have since been implemented.

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Acknowledgements

We thank Dr Le Thi Thanh Xuan, vice director of Da Nang Hospital for Women and Children, and Dr Tran Ngoc Thanh, director of Da Nang Hospital, for helping this study in Da Nang. Special thanks are given to the research nurse team, staff in the Neonatal Unit and the Obstetrics and Gynaecology Department at Da Nang Hospital for Women and Children for supporting the study. Dr HTT received a PhD scholarship from the University of Melbourne and Da Nang City.

Author Contributions

HTT and SMG conceived the study. HTT was the principal investigator, led the protocol development and study design, supervised data collection, performed data entry and analysis. NMD was the research nurse coordinator, overseeing the day-to-day running of the project and supervision of data collection. SMG, LWD and KJL provided supervision and input into study design, data collection and analysis. HTT and SMG wrote the first draft of the manuscript, and all authors contributed and approved the final draft.

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Authors and Affiliations

  1. Department of Paediatrics, Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam

    H T Tran & N M Dang

  2. University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Centre for International Child Health, Royal Children’s Hospital Melbourne, Parkville, VIC, Australia

    H T Tran & S M Graham

  3. Department of Obstetrics and Gynaecology, Royal Women’s Hospital, University of Melbourne, Melbourne, VIC, Australia

    L W Doyle

  4. Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children’s Hospital Melbourne, Parkville, VIC, Australia

    L W Doyle & K J Lee

  5. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia

    L W Doyle & K J Lee

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  1. H T Tran
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Corresponding author

Correspondence to S M Graham.

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Tran, H., Doyle, L., Lee, K. et al. A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam. J Perinatol 35, 846–851 (2015). https://doi.org/10.1038/jp.2015.78

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