Lancet study estimates third of newborns admitted to district hospitals with sepsis could die

More than a third of newborns diagnosed with sepsis, a life-threatening condition triggered by an infection, could be expected to die, a study conducted across five district hospitals in India has found. The study, which analysed data from over 6,600 newborns, found that the overall incidence of sepsis ranged from 0.6 to 10 per cent across the hospitals. The incidence was higher among newborns referred from other hospitals than in those born at the same facility. The findings, published in The Lancet Global Health journal, underscore the need to strengthen infection prevention and control measures while implementing programmes that ensure a judicious use of antibiotics, researchers said.

Researchers, including those from the All India Institute of Medical Sciences, New Delhi and Raipur, said that data of sepsis in newborns from district hospitals in low- and middle-income countries is scarce.

Sepsis occurs when one’s immune system produces an extreme response to an infection, thereby damaging tissues and organs. It can lead to multi-organ failure and can be potentially life-threatening.

Antibiotic resistance, in which infection-causing germs become immune to the drugs designed to kill them, is a major challenge to managing sepsis.

More than 39 million are projected to die due to antibiotic-resistant infections during the next 25 years, with most of them estimated to occur in South Asia, including India, Pakistan and Bangladesh, according to a 2024 analysis, published in The Lancet journal. Director of medical affairs, HaystackAnalytics, a genomics-based diagnostic solutions provider in Mumbai, Dr Mahua Kapoor Dasgupta, who is not involved with the study told PTI that multidrug resistant organisms may not respond to the empiric antibiotics initiated during the golden hour of sepsis. This delay in the effective treatment precludes favourable patient outcomes, she said.

The study enrolled neonates admitted to newborn care units in five district hospitals, including Government Hospital, Cuddalore, Tamil Nadu, in India between October, 2019, and December, 2021.

Blood samples of the newborns were taken for developing cultures and diagnostic tests were conducted on suspected sepsis cases, identified in newborns based on signs such as lethargy, refusal to feed and severe chest in-drawing.

The incidence of culture-positive sepsis was 3.2 per cent (213 of 6612). It varied among the study sites, ranging from 0.6 per cent to 10 per cent, the authors wrote.

“The incidence was 2.5-fold higher in outborn neonates than those inborn,” they added.

The case-fatality rate in neonates with culture-positive sepsis was 36.6 per cent (78 of 213). It varied markedly among the study sites, ranging from 0 to 51.1 per cent, and between inborn and outborn neonates, the study said.

Dr Dasgupta explained that the basics of infection control include standard and transmission-related precautions and hygiene of the environment, healthcare staff and patient.

“Among these the most cost effective and proven measures include promotion of hand hygiene among healthcare staff and caregivers of the neonates,” she said.

Infection control also includes antibiotic stewardship, visitor restriction, emergency or outbreak preparedness, she added.

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Lancet study estimates third of newborns admitted to district hospitals with sepsis could die

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