Explore New Ways to Predict, Diagnose and Prevent Neonatal sepsis

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The Problem

Infections are the leading cause of neonatal deaths globally. The DeNIS study 1 reported incidence of sepsis to be 14.3% in neonates admitted to NICU. OF these, Study also indicated that in low income countries, most of these include early onset sepsis i.e within 72 hrs (2/3 cases) and an alarming degree of antimicrobial resistance to even reserve antibiotics. Sepsis is allegedly one of the commonest causes responsible for 30-50% of the total neonatal deaths in developing countries. Neonatal sepsis is a clinical syndrome characterized by symptoms and signs of infection with or without evidence of accompanying bacteraemia in the first month of life.

It encompasses various systemic infections of the Newborn such as septicaemia, pneumonia, meningitis, osteomyelitis, arthritis, and urinary tract infections.

It is estimated that 20% of all neonates develop sepsis and approximately 1% die of sepsis related causes. Sepsis related mortality is largely preventable with rational antimicrobial therapy with aggressive supportive care.

Recent Indian studies have  reported Acinetobacter spp. and Klebsiella spp.  as dominant pathogens in early onset sepsis 1,4,5.  Neonates may acquire early-onset neonatal infection “vertically” (mother-to-newborn during birth) from endogenous bacteria in the mother’s reproductive tract.

Early onset sepsis, probably related to perinatal risk factors, usually presents with respiratory distress and pneumonia within 72 hours of age. Late onset sepsis, related to hospital acquired infections, usually presents with septicaemia and pneumonia after 72 hours of age. Clinical features of sepsis are nonspecific in neonates and a high index of suspicion is required for the timely diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after 48-72 hours.

The Opportunity:

What we will consider funding:

  • Projects to find out determinants in pathogenesis of early –onset sepsis.
  • determine whether targeting treatment of maternal infections or colonization may prevent a significant proportion of early-onset neonatal sepsis
  • Biomarkers for early onset sepsis.
  • Biology of sepsis in neonates
  • Point of care, low cost, rapid diagnostic kits for early screening of sepsis (within 72 hrs after birth)
  • Multiplex PCR panels for detection of common pathogens
  • Rapid bacterial culture methods and antimicrobial sensitivity testing.
  • Evaluation of adjunctive treatments for neonatal sepsis
  • Simplification of treatment of neonatal sepsis: evaluation of shorter antibiotic regimen; switching from intravenous to oral antibiotics.

Proposal should address:

  • Identification of individual biomarkers or groups of biomarkers at the time of initial presentation predict inability to respond to early infection, and an increased risk of organ dysfunction and ultimate mortality
  • Determinants of clinical features present early in the course of illness predict inability to respond to early infection and an increased risk of organ dysfunction and death
  • What biological factors respond to fail the predict of organ dysfunction and death
  • Clinical variables determinants present early over the span of disease predict each of the specific characteristic late complications of sepsis including hospital-acquired infections, organ dysfunction, respiratory syndrome and renal failures