Bacteriological and Hematological Profile of Neonatal Sepsis: Rural-Urban Comparison in a Tertiary Care Setting

Abstract

Objectives: To determine the frequency of blood culture-proven neonatal sepsis (NNS) and to compare the bacteriological and hematological profiles of culture-positive cases between rural and urban neonates.

Methodology: This descriptive, cross-sectional study was conducted at the Department of Pediatric Unit 1, Bahawal Victoria Hospital, Bahawalpur, over a period of seven months from January 2023 to July 2023 and enrolled 111 neonates with suspected sepsis. Preterm neonates, as well as those with a ruptured meningomyelocele or a history of prior hospitalization, were excluded from the study. For each participant, demographic and clinical details were recorded, and hematological parameters, including white blood cell count, hemoglobin, and platelet count, were assessed. Blood cultures were also performed to identify Gram-positive and Gram-negative organisms, and the resulting findings were compared between rural and urban cases.

Results: Blood culture-proven sepsis was found in 27 neonates (24.32%). Gram-negative organisms predominated, accounting for 58.82% of rural and 70% of urban cases. Gram-positive organisms accounted for 41.18% of rural and 30% of urban cases. Thrombocytopenia and leukopenia were significantly more common in Gram-negative infections and among rural neonates (p < 0.05). Low birth weight and early-onset sepsis were significantly associated with sepsis (p<0.05).

Conclusion: Blood culture-proven NNS was found in nearly one-fourth of suspected cases. Gram-negative organisms predominated. Hematological abnormalities were common. Thrombocytopenia and leukopenia were more frequent in Gram-negative and rural cases, suggesting severe disease. Early pathogen identification, local bacteriological surveillance, and monitoring hematological markers are key to guide therapy and improve outcomes.

Keywords: Blood culture, Gram-positive bacteria, Gram-negative bacteria, Leukopenia, NICU Neonatal infections, Neonatal sepsis, Rural-urban differences, Thrombocytopenia.