Neonatal Sepsis, Cytokines and the Associated Factors in Patients Admitted in Nakuru County Referral Hospital, Kenya

Neonatal infections mostly sepsis and meningitis currently cause about 4.9 million deaths annually in developing countries. According to World Health Organization (WHO) estimates, there are about 5 million neonatal deaths that occur in the world per year due to sepsis, with 98% occurring in developing countries. Neonatal sepsis is the leading cause of neonatal mortality in Nakuru County Referral Hospital (NCRH) according to the hospital records, yet no study has been done in the hospital on this infection prior to the current research. The purpose of this study was to provide an overview of the characteristics of bacterial sepsis in the newborns in NCRH. The study focused on the bacterial pathogens mostly implicated in neonatal sepsis, their antibiotic susceptibility patterns and cytokine involvement in neonatal sepsis. The study also determined some of the factors associated with neonatal sepsis infection in NCRH. A sample of 104 neonates admitted in Nakuru County Referral Hospital with positive clinical diagnosis of neonatal sepsis and some with normal health was enrolled for the study and grouped according to sex, birth weight and gestational age at birth. Samples of blood for culture and cytokine assay were obtained by a phlebotomist from peripheral foot veins (2 ml per neonate) using aseptic method. After blood culture, antibiotic susceptibility testing was performed for identified bacteria by disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Cytokine measurement was done using commercially available kit for T helper-1 and T helper-2 cytokines. Enzyme Linked Immunosorbent Assay (ELISA) was used to measure cytokine (IL-1β, IL-6, IL-8, IL-10 and TNF-α) levels. Quantities of individual cytokine were computed using standard reference curve. The Statistical Programme for Social Sciences (SPSS) software version 22 was utilized for data analysis where paired t-test was used to compare continuous variables, Analysis of variance (ANOVA) was used to compare cytokine levels, Chi-squire was used to compare categorical variables and Spearman rank correlation to show the relationship between inflammatory and antiinflammatory cytokine responses in neonatal sepsis. Neonatal sepsis infection was more common in preterm and low birth weight neonates compared to term and normal birth weight neonates (P Escherichia coli was the most isolated pathogen in septic cases (44.4%) while Pseudomonas aeruginosa caused the least number of cases (16.7%). There was a significant relationship between gestational age of the neonates and sepsis type (r=0.6, P< 0.05) where P. aeruginosa was responsible for sepsis only in preterm neonates. The isolated bacteria pathogens (E. coli, S. aureus and P. aeruginosa) were 100% resistant to first line antibiotics (Ampicillin and Gentamycin) but more susceptible to Chloramphenical and Ciprofloxacine ( 75%). The measured cytokines were elevated in the sick neonates when compared with the control group where a significant correlation was observed between IL-10 and TNF-α levels in the sick neonates (r=0.561, P< 0.05). The findings of this study also revealed a significant relationship between IL-10 levels and sex (P< 0.05) among the sick neonates. The findings from this study provides necessary information for clinicians to use in diagnosis and management of neonatal sepsis.