Association and Outcome of Intracranial Haemorrhage in Newborn with Fungal Sepsis- A Prospective Cohort Study

Abstract

Introduction: Neonatal sepsis is a leading cause of mortality and morbidity. Inspite of using appropriate antibiotics, those who are bacterial culture-negative, still succumb to fungal infection. Fungal sepsis is common in the neonatal Intensive Care Unit (ICU), especially with invasive procedures and prolonged empirical use of antibiotics. The incidence of fungal infection varies widely across centers, likely due to differences in practice related to modifiable risk factors such as exposure to empiric antibiotics and length of parenteral nutrition. Neonates are at high risk for acquiring infections due to their specific Central Nervous System (CNS) structure as well as functionally immature immune system causing central nervous system infection or intracranial haemorrhage due to sepsis induced coagulopathy. Being Intracranial Haemorrhage (ICH) in neonates often results in devastating neurodevelopment outcome and also having significant mortality in the neonatal period. Aim: To find the association and outcome of intracranial haemorrhage in newborn with fungal sepsis. Materials and Methods: This study was a prospective cohort study conducted at Department of Pediatrics, Government Kilpauk Medical College, Chennai, Tamil Nadu, India, on neonates admitted in newborn ward of the hospital ICU during the period January 2018 to December 2020. Neonates with the diagnosis of fungal sepsis were identified from blood cultures. They were also subjected to Complete Blood Count (CBC), Capillary Refilling Time (CRT), Prothrombin Time (PT), activated Partial Thromboblastin clotting time (aPTT) and cranial ultrasound. Chi-square analysis for descriptive data and Cox Proportional Hazard Regression for survival and non survival neonates and Kaplan-Meier curve analysis was done. Results: Out of total 80 neonates, nine had intracerebral haemorrhage, 21 neonates had intraventricular haemorrhage and no haemorrahge in 50 neonates. More the gestational age, lesser were the chances of intracranial haemorrhage and the difference was statistically significant (p-value<0.001). A total of 50 babies died, majority (42%) were in the gestational age between 37-40 weeks. All the babies diagnosed with C. albicans sepsis succumbed to infection. Conclusion: The present study highlights the fact that the lesser of the gestational age, the more or the chances of intracranial haemorrhage. A close monitoring of the coagulation profile PT and aPTT will help us to identify the babies for more prone for intracranial haemorrhage. Expert cranial ultrasound will pick up the haemorrhage early. Timely treatment measures instituted will help in preventing mortality due to bleeding manifestions in fungal sepsis. The Cox regression analysis reveals that both PT& aPTT and intracranial haemorrhage are the associated risk factors for non survival in fungal sepsis neonates.